Provider Demographics
NPI:1083320733
Name:WEST SIDE PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:WEST SIDE PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:LAMBORN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-515-2087
Mailing Address - Street 1:PO BOX 231271
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-9998
Mailing Address - Country:US
Mailing Address - Phone:347-746-5283
Mailing Address - Fax:917-720-9791
Practice Address - Street 1:130 HOPE ST APT 605
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6081
Practice Address - Country:US
Practice Address - Phone:203-515-2087
Practice Address - Fax:917-720-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty