Basic Information
| Provider Information | |||||||||
| NPI: | 1154337327 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGING MATTERS PSYCHOLOGICAL SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | AGING MATTERS PSYCHOLOGICAL SERVICES, PC | ||||||||
| Address2: | 34 SOUTH BROADWAY SUITE 600 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146819435 | ||||||||
| FaxNumber: | 9142319148 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 SOUTH BROADWAY SUITE 600 | ||||||||
| Address2: | AGING MATTERS PSYCHOLOGICAL SERVICES, PC | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146819435 | ||||||||
| FaxNumber: | 9142319148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 01/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | TOMASSO | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9146819435 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 02723917 | 05 | NY | MEDICAID |