Provider Demographics
NPI:1134441249
Name:WASHINGTON SQUARE INSTITUTE FOR PSYCHOTHERAPY & MENTAL HEALTH
Entity type:Organization
Organization Name:WASHINGTON SQUARE INSTITUTE FOR PSYCHOTHERAPY & MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DEAN
Authorized Official - Prefix:
Authorized Official - First Name:GERD
Authorized Official - Middle Name:H
Authorized Official - Last Name:FENCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGIST
Authorized Official - Phone:212-477-2600
Mailing Address - Street 1:41-51 EAST 11TH STREET, 4TH FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4602
Mailing Address - Country:US
Mailing Address - Phone:212-477-2600
Mailing Address - Fax:212-477-2040
Practice Address - Street 1:41-51 EAST 11TH STREET, 4TH FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:212-477-2600
Practice Address - Fax:212-477-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#10699261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health