Provider Demographics
NPI:1437525946
Name:FRESH START COUNSELING, LCSW, PC
Entity Type:Organization
Organization Name:FRESH START COUNSELING, LCSW, PC
Other - Org Name:FRESH START COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-307-9797
Mailing Address - Street 1:444 W. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3012
Mailing Address - Country:US
Mailing Address - Phone:631-307-9797
Mailing Address - Fax:631-307-9797
Practice Address - Street 1:444 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3012
Practice Address - Country:US
Practice Address - Phone:631-307-9797
Practice Address - Fax:631-307-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082316251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health