Provider Demographics
NPI:1811369077
Name:PARKSIDE PSYCHOLOGY GROUP PLLC
Entity Type:Organization
Organization Name:PARKSIDE PSYCHOLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAVIL
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-482-6782
Mailing Address - Street 1:41 MADISON AVE FL 25
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2212
Mailing Address - Country:US
Mailing Address - Phone:917-482-6782
Mailing Address - Fax:646-202-2401
Practice Address - Street 1:41 MADISON AVE FL 25
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2212
Practice Address - Country:US
Practice Address - Phone:917-482-6782
Practice Address - Fax:646-202-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty