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General NPI Number Information
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NPI Number | 1730043696
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Entity Type | Organization
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Legal Business Name | HOLISTIC HAVEN
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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 | 397 BRIDGE ST FL 7
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City | BROOKLYN
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State | NY
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Zip | 11201-5247
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Country | US
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Telephone | 518-321-6888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 232
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City | PETERSBURG
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State | NY
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Zip | 12138-0232
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Country | US
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Telephone | 518-321-6888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD PERROTTI-SOUSIS
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Credential | DSW, LCSW
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Telephone | 518-321-6888
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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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