| Boomer Psychological Services Pc | |
|
201 E 77th St Apt 16e New York NY 10075-2085 | |
| (212) 861-0740 | |
| Not Available |
| Full Name | Boomer Psychological Services Pc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 201 E 77th St Apt 16e, New York, New York |
| Authorized Official Name and Position | Bonnie Kellen (PRESIDENT) |
| Authorized Official Contact | 2128610740 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boomer Psychological Services Pc 201 E 77th St Apt 16e New York NY 10075-2085 Ph: (212) 861-0740 | Boomer Psychological Services Pc 201 E 77th St Apt 16e New York NY 10075-2085 Ph: (212) 861-0740 |
| NPI Number | 1992132963 |
|---|---|
| Provider Enumeration Date | 10/04/2013 |
| Last Update Date | 10/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992132963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 011975 (New York) | Primary |
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