=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316595978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EFFECTIVE PATHWAYS PSYCHOTHERAPY SERVICES LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2019
-----------------------------------------------------
Last Update Date | 08/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BLUE HILL PLZ STE 1509
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10965-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-502-1343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 BENNETT AVE APT 5I
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10033-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-568-0114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | URI COHEN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 212-568-0114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------