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General NPI Number Information
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NPI Number | 1831789957
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Entity Type | Organization
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Legal Business Name | ORCHARD BLUE COUNSELING SERVICES LCSW, PLLC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 19019 LINDEN BLVD STE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3361
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Country | US
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Telephone | 516-200-1174
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Fax | 929-529-7453
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Provider Business Mailing Address
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Address Line | 19019 LINDEN BLVD STE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3361
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Country | US
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Telephone | 516-200-1174
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Fax | 929-529-7453
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Authorized Official
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Title or Position | OWNER/LICENSED CLINICAL SOCIAL WORK
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Name | CERENE L PRINCE
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Credential | LCSW
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Telephone | 516-341-2727
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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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