Provider Demographics
NPI:1972789931
Name:BEDROSIAN, DARREN (LPSYA)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:BEDROSIAN
Suffix:
Gender:M
Credentials:LPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W 55TH ST
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4553
Mailing Address - Country:US
Mailing Address - Phone:646-504-6434
Mailing Address - Fax:
Practice Address - Street 1:345 W 55TH ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4553
Practice Address - Country:US
Practice Address - Phone:646-504-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009000102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst