Provider Demographics
NPI:1063437911
Name:RESIDENTIAL PSYCHOTHERAPIES,CSW,PC
Entity type:Organization
Organization Name:RESIDENTIAL PSYCHOTHERAPIES,CSW,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMIROFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-366-0417
Mailing Address - Street 1:42 OLD NORTHPORT RD.
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-366-0417
Mailing Address - Fax:
Practice Address - Street 1:42 OLD NORTHPORT RD.
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754
Practice Address - Country:US
Practice Address - Phone:631-366-0417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO26799104100000X
NYR267991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty