Provider Demographics
NPI:1215752902
Name:INTEGRATIVE RELATIONAL PSYCHOTHERAPY LCSW, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE RELATIONAL PSYCHOTHERAPY LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-699-8802
Mailing Address - Street 1:41 W 83RD ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5263
Mailing Address - Country:US
Mailing Address - Phone:917-699-8802
Mailing Address - Fax:
Practice Address - Street 1:325 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9673
Practice Address - Country:US
Practice Address - Phone:917-699-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization