Provider Demographics
NPI:1134162886
Name:ST. VINCENT'S PSYCHIATRY ASSOCIATES
Entity type:Organization
Organization Name:ST. VINCENT'S PSYCHIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PROGRAM DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-604-1571
Mailing Address - Street 1:450 WEST 33RD STREET
Mailing Address - Street 2:12TH FLOOR - ATTN: ROBERTO LUJAN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 W 12TH ST
Practice Address - Street 2:REISS 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:212-604-8220
Practice Address - Fax:212-604-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700203TH101YM0800X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01194696Medicaid
NY01194696Medicaid