Provider Demographics
NPI:1790827665
Name:GOAL FOCUSED PSYCHOTHERAPY SVC
Entity Type:Organization
Organization Name:GOAL FOCUSED PSYCHOTHERAPY SVC
Other - Org Name:ELAINE MAYE LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PSYCHOTHERAPIST SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSWR
Authorized Official - Phone:646-745-5500
Mailing Address - Street 1:PO BOX 604465
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-4465
Mailing Address - Country:US
Mailing Address - Phone:718-707-7004
Mailing Address - Fax:201-585-0949
Practice Address - Street 1:4514 251ST ST STE 102B
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1327
Practice Address - Country:US
Practice Address - Phone:646-745-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP0578721101YM0800X
NY05787211041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019259886Medicaid
NY057872OtherHIP PROVIDER I.D. #
NY007145786OtherAETNA
NY19259886Medicaid
NY07952GMedicare UPIN
NY019259886Medicaid