Provider Demographics
NPI:1669859583
Name:NOS CONSULTING LICENSED CLINICAL SOCIAL WORKER, PLLC
Entity Type:Organization
Organization Name:NOS CONSULTING LICENSED CLINICAL SOCIAL WORKER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-597-3651
Mailing Address - Street 1:19 W 34TH ST
Mailing Address - Street 2:PH-FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:917-597-3651
Mailing Address - Fax:212-426-2447
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PH-FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-597-3651
Practice Address - Fax:212-426-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty