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General NPI Number Information
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NPI Number | 1487738761
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Entity Type | Organization
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Legal Business Name | TRI STATE COUNSELING AND MEDIATION LCSW PLLC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 38 W 32ND ST STE 1511
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City | NEW YORK
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State | NY
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Zip | 10001-3875
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Country | US
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Telephone | 917-215-2169
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Fax | 801-708-0844
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Provider Business Mailing Address
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Address Line | 25403 84TH DR REGISTERED OFFICE
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City | FLORAL PARK
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State | NY
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Zip | 11001-1009
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Country | US
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Telephone | 646-523-2352
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Fax | 801-708-0844
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VASUDEVA CHIKKATUR MURTHY
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Credential | L.C.S.W.
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Telephone | 646-523-2352
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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 | 44SC01333400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 523650470
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R044004-01
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License Number State | NY
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