Provider Demographics
NPI:1922879584
Name:CLINICAL THERAPEUTIC SUPPORT LCSW PC
Entity Type:Organization
Organization Name:CLINICAL THERAPEUTIC SUPPORT LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GLEISSNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:866-525-2766
Mailing Address - Street 1:459 COLUMBUS AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5129
Mailing Address - Country:US
Mailing Address - Phone:917-373-4557
Mailing Address - Fax:
Practice Address - Street 1:110 16TH ST STE 1400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5275
Practice Address - Country:US
Practice Address - Phone:866-525-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL THERAPEUTIC SUPPORT, LCSW PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty