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General NPI Number Information
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NPI Number | 1033614664
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE SUPPORT LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 160 W END AVE STE 1NP
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City | NEW YORK
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State | NY
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Zip | 10023-5601
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Country | US
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Telephone | 347-766-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 4026 COLLEGE POINT BLVD APT 18F
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City | FLUSHING
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State | NY
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Zip | 11354-5132
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Country | US
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Telephone | 477-666-1823
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | CHARLENE CHAN
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Credential |
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Telephone | 347-766-6182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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