Healthcare Provider Details

I. General information

NPI: 1013250299
Provider Name (Legal Business Name): CLM WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-31 50 TH AVE
LIC NY
11101
US

IV. Provider business mailing address

5-31 50 TH AVE
LIC NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 718-213-5635
  • Fax: 718-472-2733
Mailing address:
  • Phone: 718-213-5635
  • Fax: 718-472-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number076563
License Number StateNY

VIII. Authorized Official

Name: MRS. CHRISTA LOUISE MURPHY
Title or Position: THERAPIST
Credential: LCSW
Phone: 718-213-5635