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General NPI Number Information
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NPI Number | 1104225002
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Entity Type | Organization
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Legal Business Name | RESILIENCY EXPRESS LCSW PC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 74-05 METROPOLITAN AVENUE 2ND FLOOR
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379
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Country | US
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Telephone | 718-201-2456
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Fax |
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Provider Business Mailing Address
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Address Line | 150-51 VILLAGE ROAD UNIT 55A
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City | JAMAICA
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State | NY
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Zip | 11432
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Country | US
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Telephone | 718-909-7742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MICHELLE RODRIGUEZ
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Credential | LCSW-R
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Telephone | 718-909-7742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 076034-1
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License Number State | NY
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