Provider Demographics
NPI:1881157857
Name:VISTA PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:VISTA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-802-8663
Mailing Address - Street 1:307 7TH AVE RM 1707
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6041
Mailing Address - Country:US
Mailing Address - Phone:212-802-8663
Mailing Address - Fax:212-691-2359
Practice Address - Street 1:307 7TH AVE RM 1707
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6041
Practice Address - Country:US
Practice Address - Phone:212-802-8663
Practice Address - Fax:212-691-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty