MEDICARE: NEW PATH PSYCHOTHERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1043717986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW PATH PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	200 S SERVICE RD STE 101
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2133
Country	:	US
Telephone Number	:	516-629-7080
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S SERVICE RD STE 101
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2133
Country	:	US
Telephone Number	:	516-629-7080
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	SINEAD MARY KENNEDY
Credential	:	LCSW
Telephone Number	:	516-629-7080

Provider Enumeration Date	:	04/08/2018
Last Update Date	:	04/08/2018

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Directions to “NEW PATH PSYCHOTHERAPY ” Practice Location

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