Healthcare Provider Details

I. General information

NPI: 1447961800
Provider Name (Legal Business Name): NAZARETH COUNSELING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 W 147TH ST SUITE F2
NEW YORK NY
10031-4445
US

IV. Provider business mailing address

547 W 147TH ST SUITE F2
NEW YORK NY
10031-4445
US

V. Phone/Fax

Practice location:
  • Phone: 646-719-1229
  • Fax:
Mailing address:
  • Phone: 646-719-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARRY J WINLEY
Title or Position: MANAGING MEMBER
Credential: MA, NCC, LMHC
Phone: 646-719-1229