Healthcare Provider Details

I. General information

NPI: 1730962283
Provider Name (Legal Business Name): INSPIRE CLINICAL LCSW SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 RXR PLZ
UNIONDALE NY
11556-3811
US

IV. Provider business mailing address

405 RXR PLZ
UNIONDALE NY
11556-3811
US

V. Phone/Fax

Practice location:
  • Phone: 631-401-3713
  • Fax:
Mailing address:
  • Phone: 631-401-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN DAVIS
Title or Position: OWNER
Credential:
Phone: 646-420-3065