Provider Demographics
NPI:1891833588
Name:METROPOLITAN PSYCHOLOGICAL & LICENSED MASTER SOCIAL WORK SERVICES PLLC
Entity Type:Organization
Organization Name:METROPOLITAN PSYCHOLOGICAL & LICENSED MASTER SOCIAL WORK SERVICES PLLC
Other - Org Name:METROPOLITAN PSYCHOLOGICAL & SOCIAL WORK SERVICES ALZ PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW
Authorized Official - Phone:631-647-9011
Mailing Address - Street 1:260 MONTAUK HIGHWAY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-647-9011
Mailing Address - Fax:631-647-9012
Practice Address - Street 1:260 MONTAUK HIGHWAY
Practice Address - Street 2:SUITE 8
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-647-9011
Practice Address - Fax:631-647-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007267-1103TC0700X
NYR050228-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV7W431Medicare ID - Type UnspecifiedEMPIRE
NY06102Medicare ID - Type UnspecifiedGHI