Provider Demographics
NPI:1336522143
Name:DRN COUNSELING-CONSULTING SERVICES, LCSW, PLLC
Entity Type:Organization
Organization Name:DRN COUNSELING-CONSULTING SERVICES, LCSW, PLLC
Other - Org Name:DRN COUNSELING AND CONSULTING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICOTERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-534-0440
Mailing Address - Street 1:2606 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6003
Mailing Address - Country:US
Mailing Address - Phone:315-534-0440
Mailing Address - Fax:
Practice Address - Street 1:2621 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6216
Practice Address - Country:US
Practice Address - Phone:315-507-3858
Practice Address - Fax:315-507-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079360-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty