Provider Demographics
NPI:1639565120
Name:CONNECTIONS COUNSELING PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:CONNECTIONS COUNSELING PSYCHOTHERAPY LCSW PLLC
Other - Org Name:CONNECTIONS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-255-5022
Mailing Address - Street 1:41 MAIN ST UNIT 1235
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-9838
Mailing Address - Country:US
Mailing Address - Phone:845-255-5022
Mailing Address - Fax:845-943-6757
Practice Address - Street 1:6 DUZINE RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1304
Practice Address - Country:US
Practice Address - Phone:845-255-5022
Practice Address - Fax:845-943-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0447251041C0700X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02538778Medicaid
NYN267U1Medicare UPIN