Provider Demographics
NPI:1518671734
Name:LOTUS THEORY LLC
Entity Type:Organization
Organization Name:LOTUS THEORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTACIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-594-2497
Mailing Address - Street 1:434 MAMARONECK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2698
Mailing Address - Country:US
Mailing Address - Phone:917-594-2497
Mailing Address - Fax:
Practice Address - Street 1:434 MAMARONECK AVE STE 104
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2698
Practice Address - Country:US
Practice Address - Phone:917-594-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1942772322OtherN/A