Provider Demographics
NPI:1083150056
Name:SENIOR LIVING BEHAVIORAL HEALTH LCSW PLLC
Entity Type:Organization
Organization Name:SENIOR LIVING BEHAVIORAL HEALTH LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:800-829-0115
Mailing Address - Street 1:747 3RD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2803
Mailing Address - Country:US
Mailing Address - Phone:800-829-0115
Mailing Address - Fax:
Practice Address - Street 1:747 3RD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2803
Practice Address - Country:US
Practice Address - Phone:800-829-0115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty