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General NPI Number Information
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NPI Number | 1982187977
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Entity Type | Organization
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Legal Business Name | MIDDLE WAY PSYCHOTHERAPY, LCSW P.C.
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 115 HENRY ST STE 1F
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City | BROOKLYN
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State | NY
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Zip | 11201-2512
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Country | US
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Telephone | 607-260-1161
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Fax |
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Provider Business Mailing Address
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Address Line | 936 SAINT MARKS AVE APT 1E
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City | BROOKLYN
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State | NY
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Zip | 11213-2017
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Country | US
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Telephone | 646-468-2152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA S. RULLO
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Credential | LCSW
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Telephone | 347-661-9645
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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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