Provider Demographics
NPI:1174005862
Name:WHOLEHEARTED LIVING LCSW PC
Entity Type:Organization
Organization Name:WHOLEHEARTED LIVING LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-400-5199
Mailing Address - Street 1:7 FLINTLOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:914-400-5199
Mailing Address - Fax:
Practice Address - Street 1:23 CANDEE AVENUE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782
Practice Address - Country:US
Practice Address - Phone:914-400-5199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079585-21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty