| Omni Psychotherapy, Lcsw, P.c. | |
|
180 S Broadway Ste 405 White Plains NY 10605-1820 | |
| (917) 805-0044 | |
| (718) 684-4896 |
| Full Name | Omni Psychotherapy, Lcsw, P.c. |
|---|---|
| Speciality | Social Worker |
| Location | 180 S Broadway Ste 405, White Plains, New York |
| Authorized Official Name and Position | Ivan Diller (PRESIDENT) |
| Authorized Official Contact | 9178050044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Psychotherapy, Lcsw, P.c. 180 S Broadway Ste 405 White Plains NY 10605-1820 Ph: (917) 805-0044 | Omni Psychotherapy, Lcsw, P.c. 180 S Broadway Ste 405 White Plains NY 10605-1820 Ph: (917) 805-0044 |
| NPI Number | 1669951596 |
|---|---|
| Provider Enumeration Date | 08/10/2018 |
| Last Update Date | 07/11/2019 |
| Medicare PECOS PAC ID | 6406292895 |
|---|---|
| Medicare Enrollment ID | O20240307002358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669951596 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R978093 (New York) | Primary |
| Provider Name | Ivan G Diller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316145816 PECOS PAC ID: 9739371428 Enrollment ID: I20240312001618 |
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