Provider Demographics
NPI:1700318847
Name:PROACTIVE COUNSELING LCSW P.C.
Entity Type:Organization
Organization Name:PROACTIVE COUNSELING LCSW P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-826-1644
Mailing Address - Street 1:446 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3051
Mailing Address - Country:US
Mailing Address - Phone:917-826-1644
Mailing Address - Fax:516-704-2058
Practice Address - Street 1:775 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2948
Practice Address - Country:US
Practice Address - Phone:917-826-1644
Practice Address - Fax:516-704-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0786171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty