Provider Demographics
NPI:1003459694
Name:RESILIENCE PSYCHOTHERAPY LCSW PC
Entity Type:Organization
Organization Name:RESILIENCE PSYCHOTHERAPY LCSW PC
Other - Org Name:RESILIENCE LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:917-674-3421
Mailing Address - Street 1:928 BROADWAY STE 500
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8148
Mailing Address - Country:US
Mailing Address - Phone:833-775-6252
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 500
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8148
Practice Address - Country:US
Practice Address - Phone:833-775-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty