Provider Demographics
NPI:1790398683
Name:PROFESSIONAL COUNSELING LCSW SERVICES, PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING LCSW SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:PETROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-733-0520
Mailing Address - Street 1:114 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2329
Mailing Address - Country:US
Mailing Address - Phone:315-733-0520
Mailing Address - Fax:315-733-0518
Practice Address - Street 1:114 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2329
Practice Address - Country:US
Practice Address - Phone:315-733-0520
Practice Address - Fax:315-733-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty