Provider Demographics
NPI:1598412892
Name:SIMPLE SERENITY COUNSELING LCSW, PLLC
Entity Type:Organization
Organization Name:SIMPLE SERENITY COUNSELING LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CATARISANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-760-8651
Mailing Address - Street 1:125 TEJAH AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-4233
Mailing Address - Country:US
Mailing Address - Phone:315-806-3008
Mailing Address - Fax:315-802-7670
Practice Address - Street 1:125 TEJAH AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-4233
Practice Address - Country:US
Practice Address - Phone:315-806-3008
Practice Address - Fax:315-802-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04125137Medicaid