Healthcare Provider Details

I. General information

NPI: 1720214182
Provider Name (Legal Business Name): CREATING CONNECTIONS TOGETHER, LCSW,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ROSE ST
POUGHQUAG NY
12570-5733
US

IV. Provider business mailing address

19 ROSE ST
POUGHQUAG NY
12570-5733
US

V. Phone/Fax

Practice location:
  • Phone: 845-227-6574
  • Fax: 845-227-7450
Mailing address:
  • Phone: 845-227-6574
  • Fax: 845-227-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number069872-1
License Number StateNY

VIII. Authorized Official

Name: MS. JOANN MAZZOCCHI-FLEITZ
Title or Position: DIRECTOR
Credential: LCSW-R
Phone: 845-227-6574