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General NPI Number Information
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NPI Number | 1992393276
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Entity Type | Organization
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Legal Business Name | OUR KITCHEN TABLE
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 40 EXCHANGE PL FRNT 3
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City | NEW YORK
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State | NY
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Zip | 10005-2877
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Country | US
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Telephone | 646-991-7295
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Fax |
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Provider Business Mailing Address
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Address Line | 549 ISHAM ST
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City | NEW YORK
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State | NY
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Zip | 10034-2121
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Country | US
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Telephone | 201-966-7873
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. KARLY RODRIGUEZ
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Credential | LMHC
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Telephone | 646-633-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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