Provider Demographics
NPI:1588460885
Name:RIVERBANK PSYCHOTHERAPY
Entity type:Organization
Organization Name:RIVERBANK PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:YIWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-683-1107
Mailing Address - Street 1:45 RIVER DR S APT 2514
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-3731
Mailing Address - Country:US
Mailing Address - Phone:917-683-1107
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 1604
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:917-683-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty