Healthcare Provider Details

I. General information

NPI: 1003459694
Provider Name (Legal Business Name): RESILIENCE PSYCHOTHERAPY LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 BROADWAY STE 500
NEW YORK NY
10010-8148
US

IV. Provider business mailing address

928 BROADWAY STE 500
NEW YORK NY
10010-8148
US

V. Phone/Fax

Practice location:
  • Phone: 833-775-6252
  • Fax:
Mailing address:
  • Phone: 833-775-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE CARVILLE
Title or Position: CEO
Credential: LCSW-R
Phone: 917-674-3421