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General NPI Number Information
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NPI Number | 1437207842
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Entity Type | Organization
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Legal Business Name | SJG PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 626 WILLIS AVE
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City | WILLISTON PARK
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State | NY
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Zip | 11596
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Country | US
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Telephone | 516-621-2854
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Fax | 516-621-2854
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Provider Business Mailing Address
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Address Line | 43 DOGWOOD ROAD
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City | ALBERTSON
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State | NY
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Zip | 11507
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Country | US
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Telephone | 516-621-2854
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Fax | 546-621-2854
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SUSAN GUIDA
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Credential | LCSW
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Telephone | 516-621-2854
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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 | R069724 1
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License Number State | NY
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