Provider Demographics
NPI:1750862967
Name:UNION SQUARE PSYCHOTHERAPY, LCSW, PLLC
Entity Type:Organization
Organization Name:UNION SQUARE PSYCHOTHERAPY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF-POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LCSW
Authorized Official - Phone:917-885-7892
Mailing Address - Street 1:44 E 12TH ST # MD-8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4632
Mailing Address - Country:US
Mailing Address - Phone:917-885-7892
Mailing Address - Fax:
Practice Address - Street 1:44 E 12TH ST # MD-8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4632
Practice Address - Country:US
Practice Address - Phone:917-885-7892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-25
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086846261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health