Provider Demographics
NPI:1770727182
Name:INNOVATIVE COUNSELING LCSW PLLC
Entity type:Organization
Organization Name:INNOVATIVE COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-788-8400
Mailing Address - Street 1:2127 CROMPOND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4328
Mailing Address - Country:US
Mailing Address - Phone:914-788-8400
Mailing Address - Fax:914-788-6781
Practice Address - Street 1:2127 CROMPOND RD STE 102
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4334
Practice Address - Country:US
Practice Address - Phone:914-788-8400
Practice Address - Fax:914-788-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0697441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02266966Medicaid
NYN30781Medicare PIN
NY02266966Medicaid