Provider Demographics
NPI:1063874774
Name:METRO NY DBT CENTER
Entity type:Organization
Organization Name:METRO NY DBT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-560-2437
Mailing Address - Street 1:205 RIDGEDALE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1349
Mailing Address - Country:US
Mailing Address - Phone:212-560-2437
Mailing Address - Fax:
Practice Address - Street 1:205 RIDGEDALE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1349
Practice Address - Country:US
Practice Address - Phone:212-560-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ44SC056138001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty