Provider Demographics
NPI:1124876032
Name:WALL STREET CREATIVE ART THERAPY PC
Entity type:Organization
Organization Name:WALL STREET CREATIVE ART THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYUMCUOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT, ATR-BC
Authorized Official - Phone:917-538-8292
Mailing Address - Street 1:15 BROAD STREET
Mailing Address - Street 2:UNIT 1204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005
Mailing Address - Country:US
Mailing Address - Phone:917-538-8292
Mailing Address - Fax:
Practice Address - Street 1:15 BROAD ST APT 1204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1972
Practice Address - Country:US
Practice Address - Phone:917-538-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty