Provider Demographics
NPI:1245893569
Name:COMPADRE THERAPY LCSW PLLC
Entity type:Organization
Organization Name:COMPADRE THERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCELINO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-266-7204
Mailing Address - Street 1:2447 SAINT RAYMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3162
Mailing Address - Country:US
Mailing Address - Phone:929-266-7204
Mailing Address - Fax:347-897-6388
Practice Address - Street 1:2447 SAINT RAYMONDS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3162
Practice Address - Country:US
Practice Address - Phone:929-266-7204
Practice Address - Fax:347-897-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty