Provider Demographics
NPI:1891084794
Name:NEW YORK COUNSELING FOR CHANGE, LCSW, PLLC
Entity Type:Organization
Organization Name:NEW YORK COUNSELING FOR CHANGE, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-494-3281
Mailing Address - Street 1:3720 74TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6338
Mailing Address - Country:US
Mailing Address - Phone:718-424-6191
Mailing Address - Fax:718-424-6192
Practice Address - Street 1:3720 74TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6338
Practice Address - Country:US
Practice Address - Phone:718-424-6191
Practice Address - Fax:718-424-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120211753251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health