Provider Demographics
NPI:1699078741
Name:KOSTAS A. KATSAVDAKIS, PHD, PC
Entity type:Organization
Organization Name:KOSTAS A. KATSAVDAKIS, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KOSTAS
Authorized Official - Middle Name:ANDREAS
Authorized Official - Last Name:KATSAVDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-571-4249
Mailing Address - Street 1:276 5TH AVE
Mailing Address - Street 2:SUITE 905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4509
Mailing Address - Country:US
Mailing Address - Phone:212-571-4249
Mailing Address - Fax:212-571-4176
Practice Address - Street 1:276 5TH AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4509
Practice Address - Country:US
Practice Address - Phone:212-571-4249
Practice Address - Fax:212-571-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150181103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty