MEDICARE: THRIVE PSYCHOTHERAPY PRACTICE 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1932041902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PSYCHOTHERAPY PRACTICE LCSW PLLC

Provider Business Mailing Address
First Line	:	27 RED OAKS MILL RD
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3262
Country	:	US
Telephone Number	:	845-288-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 RED OAKS MILL RD
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3262
Country	:	US
Telephone Number	:	845-288-1776
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND MEMBER
Name	:	MS. ADAIAH TANISHA LASSALLE
Credential	:	LCSWR
Telephone Number	:	845-288-1776

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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