Healthcare Provider Details

I. General information

NPI: 1720942659
Provider Name (Legal Business Name): INNER SANCTUM THERAPY, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 409
BROOKLYN NY
11242-1134
US

IV. Provider business mailing address

1324 FOREST AVE STE 207
STATEN ISLAND NY
10302-2044
US

V. Phone/Fax

Practice location:
  • Phone: 929-320-0170
  • Fax:
Mailing address:
  • Phone: 929-320-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LARA CASSELL-ROSADO
Title or Position: MEMBER-MANAGER
Credential: LCSW
Phone: 929-320-0170