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General NPI Number Information
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NPI Number | 1013812080
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Entity Type | Organization
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Legal Business Name | MAGNOLIA PSYCHOTHERAPY LCSW, PLLC
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Dates
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Enumeration Date | 10/10/2026
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Last Update Date | 10/10/2026
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Provider Practice Location Address
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Address Line | 252 JAVA ST STE 302
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City | BROOKLYN
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State | NY
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Zip | 11222-5599
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Country | US
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Telephone | 917-473-1309
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Fax |
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Provider Business Mailing Address
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Address Line | 1959 76TH ST APT 1
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City | EAST ELMHURST
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State | NY
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Zip | 11370-8007
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Country | US
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Telephone | 206-427-8633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA CILENTO
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Credential | LCSW
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Telephone | 206-427-8633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NULL
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