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General NPI Number Information
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NPI Number | 1679158067
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Entity Type | Organization
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Legal Business Name | RED DOOR THERAPEUTIC COLLECTIVE
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 720 LENOX AVE
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City | NEW YORK
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State | NY
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Zip | 10039-4403
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Country | US
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Telephone | 646-996-7826
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Fax |
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Provider Business Mailing Address
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Address Line | 90 STATE STREET STE 700 OFFICE 40
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City | ALBANY
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State | NY
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Zip | 12207
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Country | US
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Telephone | 917-740-4781
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. CELESTE M TOLBERT
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Credential | LCSW
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Telephone | 917-740-4781
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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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