Provider Demographics
NPI:1043088081
Name:INTENTIONAL WELLNESS PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:INTENTIONAL WELLNESS PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-998-4206
Mailing Address - Street 1:635 RIVERSIDE DR APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7118
Mailing Address - Country:US
Mailing Address - Phone:347-998-4206
Mailing Address - Fax:
Practice Address - Street 1:19 W 45TH ST STE 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4904
Practice Address - Country:US
Practice Address - Phone:347-998-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)