Provider Demographics
NPI:1043909427
Name:IMAGINE EMOTIONAL WELLNESS
Entity Type:Organization
Organization Name:IMAGINE EMOTIONAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-224-0096
Mailing Address - Street 1:3763 83RD ST # 186
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7146
Mailing Address - Country:US
Mailing Address - Phone:929-224-0096
Mailing Address - Fax:
Practice Address - Street 1:3763 83RD ST # 186
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7146
Practice Address - Country:US
Practice Address - Phone:929-224-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05998700OtherNEW JERSEY'S STATE BOARD OF SOCIAL WORK EXAMINERS
NY090366OtherNEW YORK OFFICE OF THE PROFESSIONS
DCLC200001194OtherDC BOARD OF SOCIAL WORK