Provider Demographics
NPI:1083254650
Name:INTUITIVE PSYCHOTHERAPY NYC LCSW PPLC
Entity Type:Organization
Organization Name:INTUITIVE PSYCHOTHERAPY NYC LCSW PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTH-GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-239-7199
Mailing Address - Street 1:140 W END AVE APT 7H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6146
Mailing Address - Country:US
Mailing Address - Phone:917-239-7199
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1608
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6601
Practice Address - Country:US
Practice Address - Phone:917-239-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)