MEDICARE: SACRED SELF-LOVE COUNSELING LCSW PC

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	:	1093677908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED SELF-LOVE COUNSELING LCSW PC

Provider Business Mailing Address
First Line	:	2 ASH ST APT 318
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-4336
Country	:	US
Telephone Number	:	718-690-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 LAFAYETTE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3308
Country	:	US
Telephone Number	:	718-690-6313
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CEKIRA BUSH-MIGUEL
Credential	:
Telephone Number	:	718-419-8111

Provider Enumeration Date	:	11/29/2025
Last Update Date	:	03/18/2026

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