Healthcare Provider Details

I. General information

NPI: 1073940706
Provider Name (Legal Business Name): THERAPY ZONE LICENSED CLINICAL SOCIAL WORK SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 RICHMOND AVE
STATEN ISLAND NY
10312-3848
US

IV. Provider business mailing address

3710 RICHMOND AVE
STATEN ISLAND NY
10312-3848
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-1519
  • Fax:
Mailing address:
  • Phone: 917-974-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MULLANE
Title or Position: OWNER
Credential:
Phone: 917-974-1519