=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629547666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSESSMENT & COUNSELING LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2018
-----------------------------------------------------
Last Update Date | 11/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 S BROADWAY STE 23
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10705-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-434-1983
-----------------------------------------------------
Fax | 914-200-5613
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 S BROADWAY STE 23
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10705-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-434-1983
-----------------------------------------------------
Fax | 914-200-5613
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIKA NERETTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-434-1983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------