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General NPI Number Information
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NPI Number | 1134596232
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Entity Type | Organization
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Legal Business Name | VILLAGE PSYCHOTHERAPY LCSW LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 156 5TH AVE STE 1223
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City | NEW YORK
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State | NY
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Zip | 10010-7735
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Country | US
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Telephone | 646-661-4055
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Fax | 252-377-4231
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Provider Business Mailing Address
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Address Line | 156 5TH AVE STE 1223
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City | NEW YORK
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State | NY
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Zip | 10010-7735
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Country | US
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Telephone | 646-661-4055
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Fax | 252-377-4231
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Authorized Official
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Title or Position | OWNER
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Name | ERIKA M COOLEY
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Credential | LCSW
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Telephone | 646-661-4055
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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 | 077332
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License Number State | NY
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