Provider Demographics
NPI: | 1710502349 |
---|---|
Name: | MARIPOSA THERAPY SERVICES LCSW, PLLC |
Entity Type: | Organization |
Organization Name: | MARIPOSA THERAPY SERVICES LCSW, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE CLINICAL DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | NANCY |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | PEREZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 646-653-0034 |
Mailing Address - Street 1: | 26 COURT ST STE 2208 |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11242-1122 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 646-653-0034 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 26 COURT STREET SUITE 2208 |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11242-1124 |
Practice Address - Country: | US |
Practice Address - Phone: | 646-653-0034 |
Practice Address - Fax: | 718-744-9097 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-06-09 |
Last Update Date: | 2020-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |