Healthcare Provider Details

I. General information

NPI: 1568883130
Provider Name (Legal Business Name): FACE TO FACE COUNSELING AND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 CENTRAL PARK AVE STE 104
SCARSDALE NY
10583-1085
US

IV. Provider business mailing address

289 SOMMERVILLE PL
YONKERS NY
10703-2212
US

V. Phone/Fax

Practice location:
  • Phone: 917-834-6211
  • Fax:
Mailing address:
  • Phone: 917-834-6211
  • Fax: 914-206-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR058985
License Number StateNY

VIII. Authorized Official

Name: MRS. CANDIDA ROSA DIAZ
Title or Position: PSYCHOTHERAPIST
Credential: LCSW-R
Phone: 917-834-6211