Provider Demographics
NPI:1639879810
Name:WILLOW TREE COUNSELING LCSW, PC
Entity Type:Organization
Organization Name:WILLOW TREE COUNSELING LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MERLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-384-1504
Mailing Address - Street 1:2305 MOTOR PKWY
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4724
Mailing Address - Country:US
Mailing Address - Phone:631-384-1504
Mailing Address - Fax:
Practice Address - Street 1:2305 MOTOR PKWY
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4724
Practice Address - Country:US
Practice Address - Phone:631-384-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty