# BRONXVILLE PSYCHIATRIC WELLNESS GROUP, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629354717
- **Authorized official:** REHANA LATIF M.D. (PRESIDENT)
- **Authorized official phone:** (914) 337-3253

## Contact information

- **Practice address:** 130 PONDFIELD RD, SUITE 2, BRONXVILLE, NY 10708-4015
- **Practice address phone:** (914) 337-3253
- **Practice address fax:** (914) 337-7013
- **Mailing address:** 130 PONDFIELD RD, SUITE 2, BRONXVILLE, NY 10708-4015
- **Mailing address phone:** (914) 337-3253
- **Mailing address fax:** (914) 337-7013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2011
- **Last updated:** 11/02/2011