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General NPI Number Information
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NPI Number | 1760244602
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Entity Type | Organization
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Legal Business Name | MY THERAPY PLACE LCSW PLLC
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 10 SAGE HILL LN
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City | MENANDS
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State | NY
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Zip | 12204-1305
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Country | US
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Telephone | 518-331-5296
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SAGE HILL LN
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City | MENANDS
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State | NY
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Zip | 12204-1305
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Country | US
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Telephone | 518-331-5296
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | TARA ELIZABETH MCCOY
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Credential | LCSW
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Telephone | 151-833-1529
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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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