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General NPI Number Information
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NPI Number | 1295144855
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Entity Type | Organization
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Legal Business Name | FAMILY INDIVIDUAL COUPLES CHILDREN PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 46 HERBERT DR
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City | GARDEN CITY PARK
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State | NY
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Zip | 11040-3734
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Country | US
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Telephone | 646-734-4527
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Fax |
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Provider Business Mailing Address
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Address Line | 46 HERBERT DR
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City | GARDEN CITY PARK
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State | NY
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Zip | 11040-3734
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Country | US
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Telephone | 646-734-4527
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ALBA ARDILA
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Credential | LCSW-R
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Telephone | 646-734-4527
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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 | R0565241
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License Number State | NY
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