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General NPI Number Information
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NPI Number | 1639875511
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Entity Type | Organization
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Legal Business Name | ILLUMINE COUNSELING LCSW PLLC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 131 7TH AVE # 356
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City | NEW YORK
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State | NY
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Zip | 10011-1802
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Country | US
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Telephone | 646-470-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 131 7TH AVE # 356
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City | NEW YORK
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State | NY
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Zip | 10011-1802
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Country | US
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Telephone | 646-470-1231
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | TASHI RIDLEY
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Credential | LCSW
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Telephone | 212-287-9357
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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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