Provider Demographics
NPI:1457626012
Name:BIENESTAR BILINGUAL COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:BIENESTAR BILINGUAL COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-437-1304
Mailing Address - Street 1:2717 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3233
Mailing Address - Country:US
Mailing Address - Phone:315-437-1304
Mailing Address - Fax:315-437-1315
Practice Address - Street 1:2717 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3233
Practice Address - Country:US
Practice Address - Phone:315-437-1304
Practice Address - Fax:315-437-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070144251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health