Healthcare Provider Details

I. General information

NPI: 1134846207
Provider Name (Legal Business Name): ST GEORGE COUNSELING SERVICES LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STUYVESANT PL STE 423
STATEN ISLAND NY
10301-1989
US

IV. Provider business mailing address

PO BOX 10980
STATEN ISLAND NY
10301-0980
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-7422
  • Fax: 718-447-7421
Mailing address:
  • Phone: 718-447-7422
  • Fax: 718-447-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ANN THOMPSON
Title or Position: PRESIDENT/CLINICAL DIRECTOR
Credential: LCSWR
Phone: 718-447-7422