MEDICARE: LOTUS INNERSPACE FAMILY THERAPY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1265252621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS INNERSPACE FAMILY THERAPY LCSW, PLLC

Provider Business Mailing Address
First Line	:	768 E 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-1269
Country	:	US
Telephone Number	:	718-594-4463
Fax Number	:

Provider Business Practice Location Address
First Line	:	768 E 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-1269
Country	:	US
Telephone Number	:	718-594-4463
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LOLA RIGG
Credential	:
Telephone Number	:	718-594-4463

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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