Provider Demographics
NPI:1124137971
Name:PSYCHOLOGICAL STRESS MANAGEMENT SERVICES PC
Entity type:Organization
Organization Name:PSYCHOLOGICAL STRESS MANAGEMENT SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-566-3840
Mailing Address - Street 1:280 MADISON AVE
Mailing Address - Street 2:RM 1403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0801
Mailing Address - Country:US
Mailing Address - Phone:917-566-3840
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:RM 1403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:917-566-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02356036Medicaid
NYV7W091Medicare ID - Type UnspecifiedGROUP #