Provider Demographics
NPI:1831789957
Name:ORCHARD BLUE COUNSELING SERVICES LCSW, PLLC
Entity type:Organization
Organization Name:ORCHARD BLUE COUNSELING SERVICES LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:CERENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-341-2727
Mailing Address - Street 1:19019 LINDEN BLVD STE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3361
Mailing Address - Country:US
Mailing Address - Phone:516-200-1174
Mailing Address - Fax:929-529-7453
Practice Address - Street 1:19019 LINDEN BLVD STE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3361
Practice Address - Country:US
Practice Address - Phone:516-200-1174
Practice Address - Fax:929-529-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05971531Medicaid
NY1700397494OtherFIDELIS
FL1700397494OtherFLORIDA BLUE
NY1700397494OtherOPTUM
NY1700397494OtherBEACON HEALTH OPTIONS
NY1700397494OtherCIGNA