Provider Demographics
NPI:1457120958
Name:JAT PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:JAT PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADAMES-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD CANDIDATE
Authorized Official - Phone:646-461-0956
Mailing Address - Street 1:5812 QUEENS BLVD STE 21228
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5812 QUEENS BLVD STE 21228
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7765
Practice Address - Country:US
Practice Address - Phone:646-461-0956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty