Provider Demographics
NPI:1164624151
Name:MY THERAPIST LCSW, PLLC
Entity Type:Organization
Organization Name:MY THERAPIST LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:DUBOSE
Authorized Official - Last Name:FOULKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-734-2205
Mailing Address - Street 1:26 SNIFFEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6404
Mailing Address - Country:US
Mailing Address - Phone:914-734-2205
Mailing Address - Fax:914-734-2203
Practice Address - Street 1:2880 BAISLEY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6117
Practice Address - Country:US
Practice Address - Phone:914-734-2205
Practice Address - Fax:914-734-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048253-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health