Provider Demographics
NPI:1174732473
Name:ADVANCED CENTER FOR PSYCHOTHERAPY
Entity type:Organization
Organization Name:ADVANCED CENTER FOR PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MGR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MESTECKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-206-6821
Mailing Address - Street 1:PO BOX 9161
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-9161
Mailing Address - Country:US
Mailing Address - Phone:631-391-7794
Mailing Address - Fax:631-454-4164
Practice Address - Street 1:103 26 68TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-261-3330
Practice Address - Fax:718-897-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245836Medicaid
NY35446AMedicare ID - Type Unspecified
NY00245836Medicaid