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General NPI Number Information
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NPI Number | 1295431377
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Entity Type | Organization
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Legal Business Name | SALT RIVER LICENSED CLINICAL SOCIAL WORK PLLC
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 26 COURT ST SUITE 410
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City | BROOKLYN
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State | NY
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Zip | 11242
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Country | US
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Telephone | 347-766-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 800 THIRD AVENUE SUITE A #1730
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERESA THOMPSON
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Credential | LCSW
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Telephone | 347-766-4949
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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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