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General NPI Number Information
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NPI Number | 1225662745
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Entity Type | Organization
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Legal Business Name | INTERSECTIONAL COUNSELING LCSW PLLC
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 699 SACKETT ST
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City | BROOKLYN
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State | NY
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Zip | 11217-4561
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Country | US
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Telephone | 917-275-7870
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Fax |
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Provider Business Mailing Address
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Address Line | 449 46TH ST
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City | BROOKLYN
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State | NY
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Zip | 11220-1213
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Country | US
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Telephone | 917-443-1591
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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. JULIA CHAN
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Credential | LCSW
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Telephone | 917-443-1591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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