Provider Demographics
NPI:1518652833
Name:IMAGE SERVICES LCSW PC
Entity Type:Organization
Organization Name:IMAGE SERVICES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-716-9380
Mailing Address - Street 1:315 WALT WHITMAN RD STE 209
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4112
Mailing Address - Country:US
Mailing Address - Phone:516-749-2896
Mailing Address - Fax:
Practice Address - Street 1:315 WALT WHITMAN RD STE 209
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4112
Practice Address - Country:US
Practice Address - Phone:516-749-2896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty