Provider Demographics
NPI:1649035684
Name:ST JAMES CONCIERGE PSYCHIATRY LLC
Entity type:Organization
Organization Name:ST JAMES CONCIERGE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTHCARE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TASIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:845-690-0058
Mailing Address - Street 1:180 S BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1845
Mailing Address - Country:US
Mailing Address - Phone:845-690-0058
Mailing Address - Fax:401-287-8847
Practice Address - Street 1:180 S BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1845
Practice Address - Country:US
Practice Address - Phone:833-867-7856
Practice Address - Fax:401-287-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty