=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477982643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCING PSYCHOTHERAPEUTIC EVOLUTIONS, LCSW P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2013
-----------------------------------------------------
Last Update Date | 11/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1841 BROADWAY SUITE 608
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-669-0963
-----------------------------------------------------
Fax | 212-247-7767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1841 BROADWAY SUITE 608
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-669-0963
-----------------------------------------------------
Fax | 212-247-7767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. MARISA HANSELL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 917-669-0963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 079635
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------