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General NPI Number Information
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NPI Number | 1356029219
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Entity Type | Organization
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Legal Business Name | CLOVER MARRIAGE AND FAMILY THERAPY PLLC
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 80 5TH AVE RM 903A
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City | NEW YORK
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State | NY
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Zip | 10011-7611
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Country | US
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Telephone | 484-578-9976
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Fax |
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Provider Business Mailing Address
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Address Line | 5 UNION SQ W # 1280
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City | NEW YORK
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State | NY
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Zip | 10003-3306
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Country | US
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Telephone | 484-578-9976
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CAITLYN PEARSON
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Credential | LMFT
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Telephone | 484-578-9976
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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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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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