MEDICARE: WARWICK COUNSELING LICENSED SOCIAL WORKER 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1306724364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARWICK COUNSELING LICENSED SOCIAL WORKER PLLC

Provider Business Mailing Address
First Line	:	36 COLONIAL AVE
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1110
Country	:	US
Telephone Number	:	845-544-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 COLONIAL AVE
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1110
Country	:	US
Telephone Number	:	845-544-1927
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ILYSA MEMMER
Credential	:	LCSW
Telephone Number	:	201-396-8380

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	01/08/2026

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