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General NPI Number Information
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NPI Number | 1992113369
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Entity Type | Organization
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Legal Business Name | HEART AND SOUL LCSW P.C.
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 220 ROUTE 6
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City | MAHOPAC
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State | NY
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Zip | 10541-3850
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Country | US
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Telephone | 914-419-9962
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Fax |
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Provider Business Mailing Address
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Address Line | 37 MAHOPAC AVE
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City | AMAWALK
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State | NY
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Zip | 10501-1004
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Country | US
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Telephone | 914-419-9962
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. JENNIFER DIBENEDETTO
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Credential |
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Telephone | 914-419-9962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | R038276-1
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License Number State | NY
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