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NPI Code Detail

MEDICARE: VISITING COUNSELING SERVICES LCSW, PLLC

MEDICARE: VISITING COUNSELING SERVICES LCSW, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1366071391
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISITING COUNSELING SERVICES LCSW, PLLC
Provider Business Mailing Address
First Line : 3911 AVENUE P
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3501
Country : US
Telephone Number : 718-377-5003
Fax Number : 718-377-5004
Provider Business Practice Location Address
First Line : 3911 AVENUE P
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3501
Country : US
Telephone Number : 718-377-5003
Fax Number : 718-377-5004
Authorized Official
Title or Position : MANAGING MEMBER
Name : ETHAN LEICHTER
Credential : LCSW
Telephone Number : 718-377-5003
Provider Enumeration Date : 04/02/2020
Last Update Date : 06/21/2023

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