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General NPI Number Information
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NPI Number | 1841924131
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Entity Type | Organization
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Legal Business Name | THERAPY COLLABORATIVE A LICENSED CLINICAL SOCIAL WORKER CO
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 307 E 44TH ST
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City | NEW YORK
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State | NY
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Zip | 10017-4400
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Country | US
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Telephone | 213-493-7813
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9247
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City | ANAHEIM
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State | CA
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Zip | 92812-7247
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Country | US
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Telephone | 213-493-7813
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Fax |
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Authorized Official
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Title or Position | OWNER/EMPLOYEE
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Name | MS. NORMA MONTENEGRO
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Credential | LCSW
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Telephone | 213-493-7813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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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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