Healthcare Provider Details

I. General information

NPI: 1447085865
Provider Name (Legal Business Name): VILLAGE THERAPY SERVICES LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 WOLFS LN
PELHAM NY
10803-1831
US

IV. Provider business mailing address

28 PERSHING AVE
NEW ROCHELLE NY
10801-2317
US

V. Phone/Fax

Practice location:
  • Phone: 914-275-2040
  • Fax:
Mailing address:
  • Phone: 914-275-2040
  • 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: MILDRET KIRKUP
Title or Position: OWNER
Credential: LCSW
Phone: 914-275-2040