Basic Information
| Provider Information | |||||||||
| NPI: | 1700318847 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROACTIVE COUNSELING LCSW P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 446 WALTON ST | ||||||||
| Address2: | |||||||||
| City: | WEST HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115523051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178261644 | ||||||||
| FaxNumber: | 5167042058 | ||||||||
| Practice Location | |||||||||
| Address1: | 775 BROOKLYN AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BALDWIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115102948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178261644 | ||||||||
| FaxNumber: | 5167042058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | BORISKIN | ||||||||
| AuthorizedOfficialFirstName: | LEA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9178261644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 078617 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.