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General NPI Number Information
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NPI Number | 1457885329
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Entity Type | Organization
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Legal Business Name | SOCIAL THERAPY CONTRACTOR LCSW LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 17 DEVON PL
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2012
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Country | US
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Telephone | 718-720-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 17 DEVON PL
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2012
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Country | US
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Telephone | 718-720-0174
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. TERRY J BLOCKER
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Credential | MSW
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Telephone | 718-720-0174
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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 | R046837-1
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License Number State | NY
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