Provider Demographics
NPI:1891571378
Name:UNION SQUARE THERAPY GROUP LLC
Entity Type:Organization
Organization Name:UNION SQUARE THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AILSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-815-1007
Mailing Address - Street 1:8 W 19TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4234
Mailing Address - Country:US
Mailing Address - Phone:917-815-1007
Mailing Address - Fax:
Practice Address - Street 1:113 UNIVERSITY PL # 903
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4527
Practice Address - Country:US
Practice Address - Phone:302-317-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty