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General NPI Number Information
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NPI Number | 1134576697
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Entity Type | Organization
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Legal Business Name | CHATANDCHANGE COUNSELING SERVICES
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Dates
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Enumeration Date | 05/14/2016
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Last Update Date | 05/14/2016
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Provider Practice Location Address
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Address Line | 727 N BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2348
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Country | US
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Telephone | 631-418-4117
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Fax |
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Provider Business Mailing Address
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Address Line | 615 BROADWAY APT 31
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City | AMITYVILLE
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State | NY
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Zip | 11701-2137
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Country | US
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Telephone | 631-418-4117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CANDICE JARVIS
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Credential | LCSW
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Telephone | 631-418-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RO55452-1
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License Number State | NY
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