Provider Demographics
NPI:1922737683
Name:OLD BROOKVILLE PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:OLD BROOKVILLE PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARALAMBOUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:516-749-1564
Mailing Address - Street 1:1129 NORTHERN BLVD
Mailing Address - Street 2:SUITE 404- #0644
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-749-1564
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BLVD
Practice Address - Street 2:SUITE 404- #0644
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-749-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty