Organization Name: | PARK AVE. PSYCHOTHERAPY GROUP |
NPI Number: | 1376891291 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDREA RHONDA GITTER (DIRECTOR) |
Mailing Address: | 167 Beach 135 Rockaway Park |
State: | NY US |
Postal Code: | 116941303 |
Phone Number: | 7186340253 |
Fax Number: | 7186341056 |
NPI Enumeration Date: | 08/27/2012 |
NPI Last Update Date: | 08/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | R027402 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |