Maverick Family Counseling LCSW PLLC
Organization Active NPI Clinical Social Worker · Woodstock, NY
NPI 1104160738 · NPPES record last updated Nov 20, 2012
Key facts
- NPI
- 1104160738
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- MAVERICK FAMILY COUNSELING LCSW PLLC
- Practice address
- 404 Zena Rd
Woodstock, NY 12498-2626 - Phone
- (845) 679-8650
- Fax
- (845) 679-5485
- NPI assigned
- Nov 20, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Thayer Case, LCSW
- Title
- Co-Director
- Phone
- (845) 679-8650
Practitioners 29
-
Fay M Aaronson, LCSW-R
-
Sheryl Forsyth Adams, MHC-LP
-
Hiep Bui, PHD
-
Kelly Carrone, LCSW
-
Thayer Stimson Case, LCSW-R
-
Claudia Gahagan, LMSW
-
James Matthew Tinger, LMSW
-
Alexandra Woolfe, LMHC
-
Katherine Young, LMHC-LP
-
Donna Mary Andres, LMHC
-
Heather A Bergen, LCSW
-
Jeremy Clark, LMSW
-
Aimee Q. Gallin, L.C.S.W
-
Ty A Little, LCSW
-
Patricia G Malone, LCSW
-
Carolyn Toni Mufson, CSW
-
Emily Ann Passik, LMSW
-
Emma Nicole Maley Pile, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131203002090 | NY | Part B Supplier - Clinic/Group Practice | 1557597184 |
Receives reassigned benefits from 26 practitioners Practice locations: Margaretville, NY; Phoenicia, NY; Woodstock, NY |
National Provider Directory
Locations
90 Main St
Ste 2A
Phoenicia, NY 12464
Phone (845) 688-7015
90 Main St
Phoenicia, NY 12464
Phone (845) 679-8650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
404 Zena Rd
Woodstock, NY 12498-2626
Mailing address
404 Zena Rd
Woodstock, NY 12498-2626
Phone (845) 679-8650
Other names
- Maverick Family Counseling
Other providers in Woodstock, NY
- Valerie Linet
- Mark Hammel, PH.D., Psychologist, P.C.
- Mallory Markman
- Nancy Mastrocola
- Maverick Family Counseling
- Maverick Family Medical, PC
- Megan McCambley
- James Jordan McErlean
- Medical Associates of the Hudson Valley
- Monica Ruth Meyer
All providers in Woodstock, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.