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General NPI Number Information
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NPI Number | 1104709906
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Entity Type | Organization
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Legal Business Name | NORTHEAST THERAPY ASSOCIATES, LCSW, PLLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 22 US OVAL STE 123
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City | PLATTSBURGH
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State | NY
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Zip | 12903-5901
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Country | US
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Telephone | 518-645-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 22 US OVAL STE 123
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City | PLATTSBURGH
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State | NY
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Zip | 12903-5901
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Country | US
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Telephone | 518-645-1991
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | BOBBI J TERRY
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Credential | LCSW-R
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Telephone | 518-645-1991
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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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