Provider Demographics
NPI:1710555164
Name:MOMENTS HERE LCSW, PC
Entity Type:Organization
Organization Name:MOMENTS HERE LCSW, PC
Other - Org Name:MOMENTS HERE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN MA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-320-6105
Mailing Address - Street 1:81 ELIZABETH ST STE 601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4729
Mailing Address - Country:US
Mailing Address - Phone:929-320-6105
Mailing Address - Fax:
Practice Address - Street 1:81 ELIZABETH ST STE 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4729
Practice Address - Country:US
Practice Address - Phone:929-320-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty