Provider Demographics
NPI:1184048589
Name:WALL STREET PSYCHOLOGISTS PLLC
Entity type:Organization
Organization Name:WALL STREET PSYCHOLOGISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GRANGE
Authorized Official - Last Name:GUINAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-509-2411
Mailing Address - Street 1:82 WALL ST
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3601
Mailing Address - Country:US
Mailing Address - Phone:212-509-2411
Mailing Address - Fax:212-968-7962
Practice Address - Street 1:82 WALL ST
Practice Address - Street 2:SUITE 1105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-3601
Practice Address - Country:US
Practice Address - Phone:212-509-2411
Practice Address - Fax:212-968-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty