Provider Demographics
NPI:1417615675
Name:PRACTICAL ONLINE THERAPY, LLC
Entity Type:Organization
Organization Name:PRACTICAL ONLINE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIXALY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARDO-YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-848-2237
Mailing Address - Street 1:10417 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1933
Mailing Address - Country:US
Mailing Address - Phone:929-335-4227
Mailing Address - Fax:929-376-0029
Practice Address - Street 1:10417 35TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1933
Practice Address - Country:US
Practice Address - Phone:929-335-4227
Practice Address - Fax:929-376-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty