Provider Demographics
NPI:1801471685
Name:THE INITIATIVE FOR PSYCHOTHERAPY, LCSW, PC
Entity type:Organization
Organization Name:THE INITIATIVE FOR PSYCHOTHERAPY, LCSW, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONDORO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:917-830-4150
Mailing Address - Street 1:124 GRUMMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2416
Mailing Address - Country:US
Mailing Address - Phone:917-830-4150
Mailing Address - Fax:
Practice Address - Street 1:307 7TH AVE RM 1707
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6041
Practice Address - Country:US
Practice Address - Phone:917-830-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty