Provider Demographics
NPI:1902219512
Name:TRANSFORMATIONS COUNSELING GROUP LCSW PLLC
Entity Type:Organization
Organization Name:TRANSFORMATIONS COUNSELING GROUP LCSW PLLC
Other - Org Name:TRANSFORMATION COUNSELING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-257-5900
Mailing Address - Street 1:269 E MAIN ST # F
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2832
Mailing Address - Country:US
Mailing Address - Phone:631-979-2775
Mailing Address - Fax:
Practice Address - Street 1:1 RABRO DR STE 10
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4270
Practice Address - Country:US
Practice Address - Phone:631-979-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0274341041C0700X
NY0825351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty