Provider Demographics
NPI:1518477405
Name:AVENUES MENTAL HEALTH COUNSELING, PLLC
Entity Type:Organization
Organization Name:AVENUES MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:516-840-3680
Mailing Address - Street 1:345 KENSINGTON RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5324
Mailing Address - Country:US
Mailing Address - Phone:516-840-3680
Mailing Address - Fax:347-705-7860
Practice Address - Street 1:115 IRVING AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-8024
Practice Address - Country:US
Practice Address - Phone:347-560-3480
Practice Address - Fax:347-705-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty