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General NPI Number Information
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NPI Number | 1124411061
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Entity Type | Organization
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Legal Business Name | COUNSELING SPACE, LCSW P.C.
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 7050 AUSTIN ST 113 LOWER LEVEL
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City | FOREST HILLS
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State | NY
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Zip | 11375-4737
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Country | US
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Telephone | 917-572-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 3533 98TH ST
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City | CORONA
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State | NY
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Zip | 11368-1860
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Country | US
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Telephone | 917-572-0013
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SOCIAL WORKER
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Name | MS. LESLIE M. GARCIA
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Credential | LCSW
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Telephone | 917-572-0013
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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 | 076422
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License Number State | NY
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