Provider Demographics
NPI:1003471152
Name:GARDEN CITY THERAPY, LCSW, PLLC
Entity Type:Organization
Organization Name:GARDEN CITY THERAPY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBALU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-816-1511
Mailing Address - Street 1:190 1ST ST APT 4J
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4002
Mailing Address - Country:US
Mailing Address - Phone:516-816-1511
Mailing Address - Fax:
Practice Address - Street 1:233 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5747
Practice Address - Country:US
Practice Address - Phone:516-828-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty