Provider Demographics
NPI:1720214182
Name:CREATING CONNECTIONS TOGETHER, LCSW,PLLC
Entity Type:Organization
Organization Name:CREATING CONNECTIONS TOGETHER, LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOCCHI-FLEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-227-6574
Mailing Address - Street 1:19 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5733
Mailing Address - Country:US
Mailing Address - Phone:845-227-6574
Mailing Address - Fax:845-227-7450
Practice Address - Street 1:19 ROSE ST
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5733
Practice Address - Country:US
Practice Address - Phone:845-227-6574
Practice Address - Fax:845-227-7450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069872-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency