Provider Demographics
NPI: | 1821425984 |
---|---|
Name: | THERA-PEER, INC |
Entity Type: | Organization |
Organization Name: | THERA-PEER, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHOTHERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GAMBINO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSED, LMHC |
Authorized Official - Phone: | 917-727-0133 |
Mailing Address - Street 1: | 41 UNION SQ W STE 325 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10003-3234 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 917-727-1033 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 41 UNION SQ W STE 325 |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10003-3234 |
Practice Address - Country: | US |
Practice Address - Phone: | 917-727-1033 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-10-03 |
Last Update Date: | 2013-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 005677 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |