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General NPI Number Information
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NPI Number | 1043093503
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Entity Type | Organization
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Legal Business Name | THRIVE COUNSELING LCSW PC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 17 STUARTS CT
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1138
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Country | US
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Telephone | 516-457-5218
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Fax |
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Provider Business Mailing Address
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Address Line | 17 STUARTS CT
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1138
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Country | US
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Telephone | 516-457-5218
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | JULIA BERGER
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Credential | LCSW
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Telephone | 917-846-2538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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