Healthcare Provider Details

I. General information

NPI: 1568925899
Provider Name (Legal Business Name): LIVE WELL INDIVIDUAL AND FAMILY COUNSELING SERVICE, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E MAIN ST STE 201
WASHINGTONVILLE NY
10992-2302
US

IV. Provider business mailing address

90 E MAIN ST STE 201
WASHINGTONVILLE NY
10992-2302
US

V. Phone/Fax

Practice location:
  • Phone: 845-614-4003
  • Fax: 845-614-0946
Mailing address:
  • Phone: 845-614-4003
  • Fax: 845-614-0946

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: MRS. SABRINA SANCHEZ
Title or Position: OWNER
Credential: LCSW
Phone: 845-614-4003