Provider Demographics
NPI:1568925899
Name:LIVE WELL INDIVIDUAL AND FAMILY COUNSELING SERVICE, LCSW, LLC
Entity Type:Organization
Organization Name:LIVE WELL INDIVIDUAL AND FAMILY COUNSELING SERVICE, LCSW, LLC
Other - Org Name:LIVE WELL INDIVIDUAL AND FAMILY COUNSELING SERVICE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-614-4003
Mailing Address - Street 1:90 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-2302
Mailing Address - Country:US
Mailing Address - Phone:845-614-4003
Mailing Address - Fax:845-614-0946
Practice Address - Street 1:90 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2302
Practice Address - Country:US
Practice Address - Phone:845-614-4003
Practice Address - Fax:845-614-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty