Provider Demographics
NPI:1265190094
Name:SECOND CHANCE COUNSELING PLLC
Entity type:Organization
Organization Name:SECOND CHANCE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-341-8008
Mailing Address - Street 1:29 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-1801
Mailing Address - Country:US
Mailing Address - Phone:845-341-8008
Mailing Address - Fax:
Practice Address - Street 1:480 ROUTE 17M FL 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4525
Practice Address - Country:US
Practice Address - Phone:845-341-8008
Practice Address - Fax:732-244-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty