Provider Demographics
NPI:1912722828
Name:THE GREENWICH PRACTICE
Entity type:Organization
Organization Name:THE GREENWICH PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY AGENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-610-0673
Mailing Address - Street 1:44 AMOGERONE CROSSWAY # 3
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-9993
Mailing Address - Country:US
Mailing Address - Phone:203-610-0673
Mailing Address - Fax:
Practice Address - Street 1:50 OAK RIDGE ST APT B
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5208
Practice Address - Country:US
Practice Address - Phone:203-610-0673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health