Healthcare Provider Details

I. General information

NPI: 1861273724
Provider Name (Legal Business Name): PATHWAY CONNECT LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 PELHAMDALE AVE STE Q
NEW ROCHELLE NY
10801-1032
US

IV. Provider business mailing address

838 PELHAMDALE AVE STE Q
NEW ROCHELLE NY
10801-1032
US

V. Phone/Fax

Practice location:
  • Phone: 914-316-4684
  • Fax: 914-933-8860
Mailing address:
  • Phone: 914-316-4684
  • Fax: 914-933-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VICTORIA A BOATENG
Title or Position: OWNER
Credential: DHA, LCSWR, M-CASAC
Phone: 914-316-4684