Provider Demographics
NPI:1316271554
Name:ADVANCED PSYCHOTHERAPY AND BEHAVIORAL HEALTH SERVICES LCSW PC
Entity type:Organization
Organization Name:ADVANCED PSYCHOTHERAPY AND BEHAVIORAL HEALTH SERVICES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR-R
Authorized Official - Phone:718-437-5570
Mailing Address - Street 1:111 DAHLGREN PLACE, BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:718-437-5570
Mailing Address - Fax:718-437-5572
Practice Address - Street 1:87-12 175TH STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-437-5570
Practice Address - Fax:718-437-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2023-12-12
Deactivation Date:2023-08-16
Deactivation Code:
Reactivation Date:2023-08-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03105171Medicaid
NYA300000696Medicare PIN