Provider Demographics
NPI:1043554769
Name:AFF PSYCHOTHERAPY
Entity Type:Organization
Organization Name:AFF PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUCONIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:347-771-4128
Mailing Address - Street 1:1953 RICHMOND TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1201
Mailing Address - Country:US
Mailing Address - Phone:347-320-6420
Mailing Address - Fax:347-413-8836
Practice Address - Street 1:1953 RICHMOND TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1201
Practice Address - Country:US
Practice Address - Phone:347-320-6420
Practice Address - Fax:347-413-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0754161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty