Staten Island Psychotherapy LCSW PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

STATEN ISLAND PSYCHOTHERAPY LCSW PLLC

Practice address

3974 Amboy Rd Ste 207
Staten Island, NY 10308-2414

Phone

(718) 344-7272

NPI assigned

Nov 27, 2024

Organization subpart

No

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

Authorized official

Name

Michelle Tully, LCSWNPI 1942426523

Title

Member

Phone

(718) 344-7272

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Michelle R Tully, L.M.S.W.

  • Clinical Social Worker
  • Staten Island, NY
  • NPI 1942426523
  NPD Authorized official

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

{
    "created_epoch": "1732665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1124844808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3974 AMBOY RD STE 207",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103082414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3974 AMBOY RD STE 207",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103082414",
            "telephone_number": "718-344-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND PSYCHOTHERAPY LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-27",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "TULLY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "718-344-7272",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; 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.