Provider Demographics
NPI:1952464059
Name:PSYCHOLOGICAL HEALTH CARE OF NY
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTH CARE OF NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KISSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-332-6025
Mailing Address - Street 1:65 ORIENTAL BLVD APT 12C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4913
Mailing Address - Country:US
Mailing Address - Phone:718-332-6025
Mailing Address - Fax:
Practice Address - Street 1:2797 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7861
Practice Address - Country:US
Practice Address - Phone:718-743-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2319570OtherUHC
NY009369OtherLICENCE#
NY01499105Medicaid
NYVWW351OtherBCBS
NYP2786335OtherOXFORD
NYVWW351Medicare PIN