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General NPI Number Information
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NPI Number | 1063992345
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY LCSW PC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 9029 218TH PL
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1336
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Country | US
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Telephone | 347-682-7023
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Fax | 718-454-5027
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Provider Business Mailing Address
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Address Line | 9029 218TH PL
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1336
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Country | US
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Telephone | 347-680-7023
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Fax | 718-454-5027
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Authorized Official
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Title or Position | OWNER
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Name | ADALGIZA SANDOVAL
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Credential | LCSW
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Telephone | 347-680-7023
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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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