Provider Demographics
NPI:1033614664
Name:COMPASSIONATE SUPPORT LLC
Entity Type:Organization
Organization Name:COMPASSIONATE SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-766-6182
Mailing Address - Street 1:4026 COLLEGE POINT BLVD APT 18F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5132
Mailing Address - Country:US
Mailing Address - Phone:477-666-1823
Mailing Address - Fax:
Practice Address - Street 1:160 W END AVE STE 1NP
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5601
Practice Address - Country:US
Practice Address - Phone:347-766-6182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty