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?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty