Basic Information
| Provider Information | |||||||||
| NPI: | 1689692840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED CENTER FOR PSYCHOTHERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 SCHENCK AVENUE | ||||||||
| Address2: | #3P | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164877812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 26 68TH ROAD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182613330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUTTERER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7182613330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | 070067 | NY | Y | Agencies | Public Health or Welfare |
No ID Information.