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General NPI Number Information
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NPI Number | 1386155240
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Entity Type | Organization
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Legal Business Name | THERAPIST WITHOUT BORDERS
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 210 E MAIN ST STE 304
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4038
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Country | US
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Telephone | 845-566-0286
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Fax |
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Provider Business Mailing Address
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Address Line | 27 LENOX PL
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City | MIDDLETOWN
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State | NY
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Zip | 10940-5526
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Country | US
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Telephone | 347-512-3636
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY-ANN FAIRWEATHER
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Credential | LCSW
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Telephone | 347-512-3636
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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 | 083105
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License Number State | NY
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