Provider Demographics
NPI:1366988362
Name:POSTGRADUATE CENTER FOR MENTAL HEALTH
Entity type:Organization
Organization Name:POSTGRADUATE CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FEE FOR SERVICE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:212-665-1860
Mailing Address - Street 1:3525 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1604
Mailing Address - Country:US
Mailing Address - Phone:718-942-6200
Mailing Address - Fax:718-652-4324
Practice Address - Street 1:3525 HULL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1604
Practice Address - Country:US
Practice Address - Phone:718-942-6200
Practice Address - Fax:718-652-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084660261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)