MEDICARE: CHASING SERENITY PSYCHOTHERAPY LCSW, PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083407324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASING SERENITY PSYCHOTHERAPY LCSW, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 300196
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-0196
Country	:	US
Telephone Number	:	917-426-7477
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 PARKVILLE AVE APT 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1378
Country	:	US
Telephone Number	:	347-848-3578
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CLINICAL SUPERVISOR
Name	:	MAVIS SMITH
Credential	:	PHD.CANDIDATE
Telephone Number	:	917-374-3266

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/28/2025

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