Provider Demographics
NPI:1942841101
Name:MCM COLLABORATIVE PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:MCM COLLABORATIVE PSYCHOTHERAPY LCSW PLLC
Other - Org Name:MCM COLLABORATIVE PSYCHOTHERAPY LCSW PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-512-3804
Mailing Address - Street 1:116 W 23RD ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2599
Mailing Address - Country:US
Mailing Address - Phone:917-512-3804
Mailing Address - Fax:
Practice Address - Street 1:116 W 23RD ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2599
Practice Address - Country:US
Practice Address - Phone:917-512-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty