Provider Demographics
NPI:1740735471
Name:DOORS TO FREEDOM MENTAL HEALTH COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:DOORS TO FREEDOM MENTAL HEALTH COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO-BERKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-935-2122
Mailing Address - Street 1:1259 RICHMOND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1259 RICHMOND AVE STE 201
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1521
Practice Address - Country:US
Practice Address - Phone:917-935-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty