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General NPI Number Information
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NPI Number | 1801471685
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Entity Type | Organization
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Legal Business Name | THE INITIATIVE FOR PSYCHOTHERAPY, LCSW, PC
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Dates
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Enumeration Date | 03/13/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 307 7TH AVE RM 1707
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City | NEW YORK
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State | NY
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Zip | 10001-6041
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Country | US
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Telephone | 917-830-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 124 GRUMMAN AVE
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City | NORWALK
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State | CT
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Zip | 06851-2416
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Country | US
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Telephone | 917-830-4150
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Fax |
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Authorized Official
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Title or Position | FOUNDING DIRECTOR
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Name | MR. MICHAEL J MONDORO
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Credential | MSW, LCSW
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Telephone | 917-830-4150
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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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