Healthcare Provider Details

I. General information

NPI: 1073669875
Provider Name (Legal Business Name): INTEGRATED THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2938 BAYSWATER AVE
FAR ROCKAWAY NY
11691-1730
US

IV. Provider business mailing address

2938 BAYSWATER AVE
FAR ROCKAWAY NY
11691-1730
US

V. Phone/Fax

Practice location:
  • Phone: 631-433-0033
  • Fax:
Mailing address:
  • Phone: 631-433-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH LEHRFELD
Title or Position: PRESIDENT
Credential: LMSW
Phone: 631-433-0033