MEDICARE: ALIGN BALANCE CULTIVATE 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1740093855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIGN BALANCE CULTIVATE LCSW PLLC

Provider Business Mailing Address
First Line	:	5065 42ND ST
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-3127
Country	:	US
Telephone Number	:	646-235-6133
Fax Number	:

Provider Business Practice Location Address
First Line	:	5065 42ND STREET
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-3127
Country	:	US
Telephone Number	:	646-235-6133
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHARLES BARRIOS
Credential	:	LCSW
Telephone Number	:	646-235-6133

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/05/2026

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