Provider Demographics
NPI:1104137991
Name:HARLEM FAMILY INSTITUTE
Entity type:Organization
Organization Name:HARLEM FAMILY INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:KOOPERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-280-6826
Mailing Address - Street 1:521 W 126TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2407
Mailing Address - Country:US
Mailing Address - Phone:212-280-6826
Mailing Address - Fax:
Practice Address - Street 1:521 W 126TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2407
Practice Address - Country:US
Practice Address - Phone:212-280-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0125881251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)