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General NPI Number Information
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NPI Number | 1750862967
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Entity Type | Organization
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Legal Business Name | UNION SQUARE PSYCHOTHERAPY, LCSW, PLLC
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Dates
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Enumeration Date | 08/25/2018
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 44 E 12TH ST # MD-8
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City | NEW YORK
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State | NY
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Zip | 10003-4632
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Country | US
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Telephone | 917-885-7892
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Fax |
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Provider Business Mailing Address
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Address Line | 44 E 12TH ST # MD-8
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City | NEW YORK
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State | NY
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Zip | 10003-4632
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Country | US
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Telephone | 917-885-7892
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MR. JOSH WOLF-POWERS
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Credential | MBA, LCSW
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Telephone | 917-885-7892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 086846
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License Number State | NY
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