Healthcare Provider Details

I. General information

NPI: 1437773611
Provider Name (Legal Business Name): COLLABORATIVE THERAPY MENTAL HEALTH COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MADISON AVE FL 5
NEW YORK NY
10016-6796
US

IV. Provider business mailing address

136 MADISON AVE FL 5
NEW YORK NY
10016-6796
US

V. Phone/Fax

Practice location:
  • Phone: 929-280-3994
  • Fax: 929-419-9061
Mailing address:
  • Phone: 929-280-3994
  • Fax: 929-419-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: KYLE WILLIAM MCEVOY
Title or Position: FOUNDER & LMHC
Credential: LMHC
Phone: 631-682-7741