Provider Demographics
NPI:1396137808
Name:PURPOSE DRIVEN THERAPEUTIC SERVICES LCSW, PLLC
Entity type:Organization
Organization Name:PURPOSE DRIVEN THERAPEUTIC SERVICES LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLING
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-855-5957
Mailing Address - Street 1:120 STUYVESANT PL
Mailing Address - Street 2:SUITE 402
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1989
Mailing Address - Country:US
Mailing Address - Phone:347-855-5957
Mailing Address - Fax:
Practice Address - Street 1:120 STUYVESANT PL
Practice Address - Street 2:SUITE 402
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1989
Practice Address - Country:US
Practice Address - Phone:347-855-5957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081285-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty