Basic Information
| Provider Information | |||||||||
| NPI: | 1275007114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNSELING WORKS, LCSW, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 W PROSPECT AVE, 3RD FL | ||||||||
| Address2: | SUITE 5F | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105502017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144268857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 W PROSPECT AVE, 3RD FL | ||||||||
| Address2: | SUITE 5F | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105502017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144268857 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2019 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | NOBLE-HEADAD | ||||||||
| AuthorizedOfficialFirstName: | MYRNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9144268857 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 02964381 | 05 | NY | MEDICAID |