Provider Demographics
NPI:1649965898
Name:PSYCHOLOGICAL ASSESSMENTS AND CONSULTATION SERVICES, PLLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENTS AND CONSULTATION SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-696-1477
Mailing Address - Street 1:700 FORT WASHINGTON AVE APT 5J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3706
Mailing Address - Country:US
Mailing Address - Phone:347-696-1477
Mailing Address - Fax:
Practice Address - Street 1:5 W 86TH ST APT 9C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3664
Practice Address - Country:US
Practice Address - Phone:347-696-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1073892568Medicaid