Provider Demographics
NPI:1629843982
Name:SANDOVAL PSYCHOTHERAPY CONSULTATION LCSW PLLC
Entity Type:Organization
Organization Name:SANDOVAL PSYCHOTHERAPY CONSULTATION LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:PRISCILLA
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-214-9848
Mailing Address - Street 1:3068 38TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-5096
Mailing Address - Country:US
Mailing Address - Phone:917-214-9848
Mailing Address - Fax:
Practice Address - Street 1:3801 23RD AVE FL 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1532
Practice Address - Country:US
Practice Address - Phone:917-214-9848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty