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General NPI Number Information
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NPI Number | 1720942659
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Entity Type | Organization
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Legal Business Name | INNER SANCTUM THERAPY, LCSW, PLLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 26 COURT ST STE 409
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City | BROOKLYN
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State | NY
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Zip | 11242-1134
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Country | US
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Telephone | 929-320-0170
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 FOREST AVE STE 207
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2044
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Country | US
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Telephone | 929-320-0170
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Fax |
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | LARA CASSELL-ROSADO
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Credential | LCSW
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Telephone | 929-320-0170
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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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