Provider Demographics
NPI:1407482938
Name:COMMUNITY PSYCHOTHERAPY LCSW, PLLC
Entity Type:Organization
Organization Name:COMMUNITY PSYCHOTHERAPY LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:888-931-3303
Mailing Address - Street 1:6 E SUSSEX PL
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-8801
Mailing Address - Country:US
Mailing Address - Phone:888-931-3303
Mailing Address - Fax:888-635-9933
Practice Address - Street 1:11 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2017
Practice Address - Country:US
Practice Address - Phone:888-931-3303
Practice Address - Fax:888-635-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty