Provider Demographics
NPI:1508002486
Name:CLINICAL THERAPEUTIC SERVICES OF LONG ISLAND LCSW, PLLC
Entity Type:Organization
Organization Name:CLINICAL THERAPEUTIC SERVICES OF LONG ISLAND LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-333-8523
Mailing Address - Street 1:14 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1610
Mailing Address - Country:US
Mailing Address - Phone:516-333-8523
Mailing Address - Fax:516-333-8529
Practice Address - Street 1:1 STEWART CT
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1028
Practice Address - Country:US
Practice Address - Phone:516-632-5360
Practice Address - Fax:516-333-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069998-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty