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General NPI Number Information
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NPI Number | 1619763000
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Entity Type | Organization
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Legal Business Name | NEW HORIZONS MARRIAGE AND FAMILY THERAPY PLLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 111 E CHESTNUT ST
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City | ROME
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State | NY
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Zip | 13440-2800
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Country | US
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Telephone | 315-281-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 8833 KARLEN RD
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City | ROME
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State | NY
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Zip | 13440-7465
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Country | US
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Telephone | 315-941-0461
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TINA J IACOVISSI
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Credential | LMFT
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Telephone | 315-941-0461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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