Provider Demographics
NPI:1588006159
Name:IRENE T SACK COUNSELING SERVICES
Entity type:Organization
Organization Name:IRENE T SACK COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CASAC,CHT
Authorized Official - Phone:315-247-3208
Mailing Address - Street 1:300 TULIP ST
Mailing Address - Street 2:ROOM 20
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4965
Mailing Address - Country:US
Mailing Address - Phone:315-247-3208
Mailing Address - Fax:315-453-6347
Practice Address - Street 1:300 TULIP ST
Practice Address - Street 2:ROOM 20
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4965
Practice Address - Country:US
Practice Address - Phone:315-247-3208
Practice Address - Fax:315-453-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052758-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization