Provider Demographics
NPI:1790543239
Name:THERAPY BOOTH - COUNSELING SERVICES
Entity Type:Organization
Organization Name:THERAPY BOOTH - COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TLOCZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-816-4154
Mailing Address - Street 1:100 ROLLSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11796-1305
Mailing Address - Country:US
Mailing Address - Phone:631-816-4154
Mailing Address - Fax:
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1832
Practice Address - Country:US
Practice Address - Phone:631-816-4154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty