Provider Demographics
NPI:1598061251
Name:PSYCHOTHERAPY AND MEDIATION LCSW P C
Entity Type:Organization
Organization Name:PSYCHOTHERAPY AND MEDIATION LCSW P C
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:914-906-8919
Mailing Address - Street 1:367 NEW WINDSOR HWY
Mailing Address - Street 2:#215
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:914-906-8919
Mailing Address - Fax:845-567-1118
Practice Address - Street 1:367 NEW WINDSOR HWY
Practice Address - Street 2:#215
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:914-906-8919
Practice Address - Fax:845-567-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0709231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty