Intentional Wellness Psychotherapy LCSW PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

INTENTIONAL WELLNESS PSYCHOTHERAPY LCSW PLLC

Practice address

19 W 45TH St Ste 302
New York, NY 10036-4904

Phone

(347) 998-4206

NPI assigned

Dec 19, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Gottheimer, LCSWNPI 1043718901

Title

Executive Officer

Phone

(347) 998-4206

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amy Gottheimer

  • Clinical Social Worker
  • New York, NY
  • NPI 1043718901
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702944000000",
    "number": "1043088081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 RIVERSIDE DR APT 6C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100317118",
            "telephone_number": "347-998-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 W 45TH ST STE 302",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100364904",
            "telephone_number": "347-998-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL WELLNESS PSYCHOTHERAPY LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-19",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "GOTTHEIMER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "347-998-4206",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in New York, NY
• Providers in New York, NY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.