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General NPI Number Information
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NPI Number | 1619479961
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Entity Type | Organization
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Legal Business Name | PRISM PSYCHOTHERAPY LCSW PC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 56 MAIN ST STE 3-5
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City | WARWICK
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State | NY
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Zip | 10990-1345
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Country | US
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Telephone | 845-656-2606
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1196
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City | WARWICK
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State | NY
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Zip | 10990-8196
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Country | US
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Telephone | 845-656-2606
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Fax | 205-827-8045
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Authorized Official
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Title or Position | OWNER
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Name | MARY E. PACOS
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Credential | LCSWR
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Telephone | 845-656-2606
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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 |
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License Number State |
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