Provider Demographics
NPI:1922643329
Name:PATHWAY COUNSELING, LCSW, PC
Entity Type:Organization
Organization Name:PATHWAY COUNSELING, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW-R/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-210-6292
Mailing Address - Street 1:325 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2110
Mailing Address - Country:US
Mailing Address - Phone:631-210-6292
Mailing Address - Fax:
Practice Address - Street 1:325 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2110
Practice Address - Country:US
Practice Address - Phone:631-210-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty