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General NPI Number Information
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NPI Number | 1417285610
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Entity Type | Organization
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Legal Business Name | MIND GUIDE, LCSW, P.C.
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Dates
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Enumeration Date | 11/27/2009
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Last Update Date | 11/27/2009
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Provider Practice Location Address
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Address Line | 11020 71ST RD SUITE 104
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City | FOREST HILLS
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State | NY
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Zip | 11375-4945
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Country | US
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Telephone | 917-748-0814
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Fax | 516-620-4567
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Provider Business Mailing Address
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Address Line | 11 LAKEVILLE DR
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City | ROSLYN
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State | NY
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Zip | 11576-2514
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Country | US
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Telephone | 917-748-0814
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Fax | 516-620-4567
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Authorized Official
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Title or Position | PRESIDENT AND PSYCHOTHERAPIST
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Name | IRENA ROITGARTS
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Credential | LCSW-R
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Telephone | 917-748-0814
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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 | 071633
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License Number State | NY
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