Healthcare Provider Details

I. General information

NPI: 1790827665
Provider Name (Legal Business Name): GOAL FOCUSED PSYCHOTHERAPY SVC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 251ST ST STE 102B
LITTLE NECK NY
11362-1327
US

IV. Provider business mailing address

PO BOX 604465
BAYSIDE NY
11360-4465
US

V. Phone/Fax

Practice location:
  • Phone: 646-745-5500
  • Fax:
Mailing address:
  • Phone: 718-707-7004
  • Fax: 201-585-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRP0578721
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0578721
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ELAINE MAYE
Title or Position: CEO PSYCHOTHERAPIST SOCIAL WORKER
Credential: MSW LCSWR
Phone: 646-745-5500