Provider Demographics
NPI:1912442633
Name:BRYAN PARK PSYCHOLOGICAL SERVICE, P.C.
Entity Type:Organization
Organization Name:BRYAN PARK PSYCHOLOGICAL SERVICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-709-9650
Mailing Address - Street 1:16 E 40TH ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0113
Mailing Address - Country:US
Mailing Address - Phone:347-709-9650
Mailing Address - Fax:
Practice Address - Street 1:16 E 40TH ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0113
Practice Address - Country:US
Practice Address - Phone:347-709-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021753103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty