=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437830718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRITVAN THERAPY SERVICES - LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2023
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 S BROADWAY OFC 460
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-4413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-327-5416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 S BROADWAY FL 4
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-4413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-327-5416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LISA BRITVAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 914-218-4083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------