Provider Demographics
NPI:1396133278
Name:CHILD AND FAMILY PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:CHILD AND FAMILY PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-510-3638
Mailing Address - Street 1:347 VANDELINDA AVE
Mailing Address - Street 2:PH
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3120
Mailing Address - Country:US
Mailing Address - Phone:718-655-5552
Mailing Address - Fax:201-357-4163
Practice Address - Street 1:3510 BAINBRIDGE AVE
Practice Address - Street 2:S1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1409
Practice Address - Country:US
Practice Address - Phone:718-655-5552
Practice Address - Fax:201-357-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213505103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057578Medicaid