Provider Demographics
NPI:1447707146
Name:GARY M PROTTAS, LCSW PSYCHOANALYSIS PLLC
Entity type:Organization
Organization Name:GARY M PROTTAS, LCSW PSYCHOANALYSIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PROTTAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, LP
Authorized Official - Phone:212-645-1152
Mailing Address - Street 1:20 WEST 20TH STREET
Mailing Address - Street 2:ROOM 239
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4313
Mailing Address - Country:US
Mailing Address - Phone:212-645-1152
Mailing Address - Fax:212-822-8505
Practice Address - Street 1:20 WEST 20TH STREET
Practice Address - Street 2:ROOM 239
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4313
Practice Address - Country:US
Practice Address - Phone:212-645-1152
Practice Address - Fax:212-822-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078653261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health