Provider Demographics
NPI:1255117628
Name:THE LOOM WELLNESS LCSW PLLC
Entity type:Organization
Organization Name:THE LOOM WELLNESS LCSW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-470-7109
Mailing Address - Street 1:41 UNION SQ W STE 1328
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3252
Mailing Address - Country:US
Mailing Address - Phone:646-470-7109
Mailing Address - Fax:917-970-8181
Practice Address - Street 1:41 UNION SQ W STE 1328
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3252
Practice Address - Country:US
Practice Address - Phone:646-470-7109
Practice Address - Fax:917-970-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty