Provider Demographics
NPI:1487766192
Name:PROTTAS, GARY MICHAEL (LP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:PROTTAS
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 20TH ST RM 239
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4213
Mailing Address - Country:US
Mailing Address - Phone:212-645-1152
Mailing Address - Fax:212-822-8505
Practice Address - Street 1:20 W 20TH ST RM 239
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4213
Practice Address - Country:US
Practice Address - Phone:212-645-1152
Practice Address - Fax:212-822-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000701103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis