NPIMap

Organization Active NPI

Supportive Psychological Services PC

  • Clinical Psychologist
  • New York, NY
National Provider Identifier
1003184136
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SUPPORTIVE PSYCHOLOGICAL SERVICES PC
Practice address
255 W 88TH St Apt 6B
New York, NY 10024-1717
Phone
(212) 787-0874
Fax
(866) 411-9117
NPI assigned
Dec 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Richard M Bennett, PHD
Title
President
Phone
(212) 787-0874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X NY Primary

Addresses

Primary practice location

255 W 88TH St Apt 6B
New York, NY 10024-1717

Mailing address

255 W 88TH St Apt 6B
New York, NY 10024-1717
Phone (212) 787-0874

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1003184136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W 88TH ST APT 6B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100241717",
            "telephone_number": "212-787-0874",
            "fax_number": "866-411-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W 88TH ST APT 6B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100241717",
            "telephone_number": "212-787-0874",
            "fax_number": "866-411-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE PSYCHOLOGICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-04",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-787-0874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.