Provider Demographics
NPI:1881225217
Name:RELATIONAL FULFILLMENT PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:RELATIONAL FULFILLMENT PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-298-5227
Mailing Address - Street 1:12 PRESIDENTS PL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6308
Mailing Address - Country:US
Mailing Address - Phone:646-298-5227
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 1005
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5021
Practice Address - Country:US
Practice Address - Phone:646-298-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)