Provider Demographics
NPI:1700359700
Name:MOBILE COUNSELING OF NEW YORK LCSW, PLLC
Entity Type:Organization
Organization Name:MOBILE COUNSELING OF NEW YORK LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:716-302-4545
Mailing Address - Street 1:52 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1485
Mailing Address - Country:US
Mailing Address - Phone:716-302-4545
Mailing Address - Fax:
Practice Address - Street 1:52 WOODSTREAM DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1485
Practice Address - Country:US
Practice Address - Phone:716-302-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty