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General NPI Number Information
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NPI Number | 1407482938
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Entity Type | Organization
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Legal Business Name | COMMUNITY PSYCHOTHERAPY LCSW, PLLC
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 11 W PROSPECT AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2017
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Country | US
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Telephone | 888-931-3303
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Fax | 888-635-9933
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Provider Business Mailing Address
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Address Line | 6 E SUSSEX PL
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City | NEW CASTLE
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State | DE
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Zip | 19720-8801
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Country | US
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Telephone | 888-931-3303
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Fax | 888-635-9933
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Authorized Official
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Title or Position | PRESIDENT/THERAPIST
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Name | MR. PRESTON J LANIER
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Credential | LCSW
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Telephone | 888-931-3303
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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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