MEDICARE: REAL TALK THERAPY COUNSELING SERVICES, 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	:	1518826825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL TALK THERAPY COUNSELING SERVICES, LCSW, PLLC

Provider Business Mailing Address
First Line	:	10 AVONCROFT LN
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-5078
Country	:	US
Telephone Number	:	917-512-2694
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 AVONCROFT LN
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-5078
Country	:	US
Telephone Number	:	917-512-2694
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ATO WILLIAMS
Credential	:	WILLIAMS
Telephone Number	:	917-512-2694

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/30/2026

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