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NPI Code Detail

MEDICARE: INNER SANCTUM THERAPY, LCSW, PLLC

MEDICARE: INNER SANCTUM 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1720942659
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNER SANCTUM THERAPY, LCSW, PLLC
Provider Business Mailing Address
First Line : 1324 FOREST AVE STE 207
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-2044
Country : US
Telephone Number : 929-320-0170
Fax Number :
Provider Business Practice Location Address
First Line : 26 COURT ST STE 409
Second Line :
City : BROOKLYN
State : NY
Zip : 11242-1134
Country : US
Telephone Number : 929-320-0170
Fax Number :
Authorized Official
Title or Position : MEMBER-MANAGER
Name : LARA CASSELL-ROSADO
Credential : LCSW
Telephone Number : 929-320-0170
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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