Provider Demographics
NPI:1780440735
Name:VILLAGE COUNSLEING LICENSED CLINICAL SOCIAL WORK SERVICES PLLC
Entity type:Organization
Organization Name:VILLAGE COUNSLEING LICENSED CLINICAL SOCIAL WORK SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-747-5635
Mailing Address - Street 1:238 KELLY RD. PO#219
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-2104
Mailing Address - Country:US
Mailing Address - Phone:212-473-1512
Mailing Address - Fax:518-719-2620
Practice Address - Street 1:280 MADISON AVE.
Practice Address - Street 2:SUITE #1108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0815
Practice Address - Country:US
Practice Address - Phone:212-473-1512
Practice Address - Fax:518-719-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty