Provider Demographics
NPI:1184106957
Name:INTEGRATIVE THERAPY FOR CHILDREN AND ADOLESCENTS
Entity type:Organization
Organization Name:INTEGRATIVE THERAPY FOR CHILDREN AND ADOLESCENTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT
Authorized Official - Phone:914-670-1376
Mailing Address - Street 1:35 W MARKET ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1510
Mailing Address - Country:US
Mailing Address - Phone:914-670-1376
Mailing Address - Fax:
Practice Address - Street 1:35 W MARKET ST STE 3B
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1510
Practice Address - Country:US
Practice Address - Phone:914-670-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0872031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty