Provider Demographics
NPI:1750161444
Name:MILESTONE PSYCHOTHERAPY AND CONSULTATION LLC
Entity type:Organization
Organization Name:MILESTONE PSYCHOTHERAPY AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANGLAI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-357-7565
Mailing Address - Street 1:1125 MAXWELL LN APT 814
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6852
Mailing Address - Country:US
Mailing Address - Phone:917-496-9621
Mailing Address - Fax:
Practice Address - Street 1:165 BROADWAY STE 2315
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1404
Practice Address - Country:US
Practice Address - Phone:917-496-9621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty