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General NPI Number Information
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NPI Number | 1518477405
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Entity Type | Organization
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Legal Business Name | AVENUES MENTAL HEALTH COUNSELING, PLLC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 115 IRVING AVE FL 1
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City | BROOKLYN
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State | NY
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Zip | 11237-8024
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Country | US
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Telephone | 347-560-3480
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Fax | 347-705-7860
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Provider Business Mailing Address
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Address Line | 345 KENSINGTON RD S
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City | GARDEN CITY
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State | NY
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Zip | 11530-5324
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Country | US
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Telephone | 516-840-3680
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Fax | 347-705-7860
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDRA ROLDAN
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Credential | LMHC
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Telephone | 516-840-3680
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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 | 005169
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License Number State | NY
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