Provider Demographics
NPI:1255898342
Name:PSYCHOTHERAPY AT HOME, LCSW, PLLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY AT HOME, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEGRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-302-5645
Mailing Address - Street 1:700 FULTON ST APT M3
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3447
Mailing Address - Country:US
Mailing Address - Phone:516-302-5645
Mailing Address - Fax:631-647-2058
Practice Address - Street 1:326 SEA CLIFF ST
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1109
Practice Address - Country:US
Practice Address - Phone:516-302-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03461263Medicaid