Provider Demographics
NPI:1255459822
Name:LEO STOROZUM PHD ET AL PTR FAMILY COUNSELING SERVICE
Entity type:Organization
Organization Name:LEO STOROZUM PHD ET AL PTR FAMILY COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:STOROZUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-674-8516
Mailing Address - Street 1:205 EAST 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3619
Mailing Address - Country:US
Mailing Address - Phone:212-674-8516
Mailing Address - Fax:212-253-9289
Practice Address - Street 1:205 EAST 17TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3619
Practice Address - Country:US
Practice Address - Phone:212-674-8516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01193228Medicaid
NYW6L291Medicare ID - Type Unspecified