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General NPI Number Information
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NPI Number | 1477899920
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Entity Type | Organization
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Legal Business Name | COGNITIVE BEHAVORIAL THERAPY MENTAL HEALTH COUNSELING PLLC
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 83 HARTFORD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-3111
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Country | US
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Telephone | 718-981-2310
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Fax | 917-567-7034
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Provider Business Mailing Address
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Address Line | 83 HARTFORD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-3111
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Country | US
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Telephone | 718-981-2310
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Fax | 917-567-7034
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Authorized Official
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Title or Position | HEAD OF CREDENTIALING
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Name | WHITNEY BADE
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Credential |
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Telephone | 617-326-3751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004239
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License Number State | NY
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