Provider Demographics
NPI:1124411061
Name:COUNSELING SPACE, LCSW P.C.
Entity Type:Organization
Organization Name:COUNSELING SPACE, LCSW P.C.
Other - Org Name:LESLIE M. GARCIA, LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-572-0013
Mailing Address - Street 1:3533 98TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1860
Mailing Address - Country:US
Mailing Address - Phone:917-572-0013
Mailing Address - Fax:
Practice Address - Street 1:7050 AUSTIN ST
Practice Address - Street 2:113 LOWER LEVEL
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4737
Practice Address - Country:US
Practice Address - Phone:917-572-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0764221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty