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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |