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General NPI Number Information
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NPI Number | 1134846207
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Entity Type | Organization
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Legal Business Name | ST GEORGE COUNSELING SERVICES LCSW PLLC
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 120 STUYVESANT PL STE 423
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1989
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Country | US
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Telephone | 718-447-7422
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Fax | 718-447-7421
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Provider Business Mailing Address
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Address Line | PO BOX 10980
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City | STATEN ISLAND
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State | NY
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Zip | 10301-0980
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Country | US
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Telephone | 718-447-7422
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Fax | 718-447-7421
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL DIRECTOR
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Name | PATRICIA ANN THOMPSON
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Credential | LCSWR
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Telephone | 718-447-7422
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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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