Provider Demographics
NPI:1801945423
Name:BIOFEEDBACK & PSYCHOTHERAPY DEVELOPMENT LCSW HEALTH SERVICES PC
Entity type:Organization
Organization Name:BIOFEEDBACK & PSYCHOTHERAPY DEVELOPMENT LCSW HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-825-5005
Mailing Address - Street 1:5 SUNRISE PLAZA
Mailing Address - Street 2:SUITE #202
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6130
Mailing Address - Country:US
Mailing Address - Phone:516-825-5005
Mailing Address - Fax:516-825-5778
Practice Address - Street 1:5 SUNRISE PLAZA
Practice Address - Street 2:SUITE #202
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6130
Practice Address - Country:US
Practice Address - Phone:516-825-5005
Practice Address - Fax:516-825-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV7W021Medicare ID - Type Unspecified
NYN18581Medicare UPIN