Lic Marriage and Family Therapy PLLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

LIC MARRIAGE AND FAMILY THERAPY PLLC

Practice address

3164 21St St # 121
Long Island City, NY 11106-4573

Phone

(631) 365-9350

NPI assigned

Jun 2, 2021

Last updated

Jul 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jennifer Disomma, LICENSEDNPI 1851176358

Title

Marriage and Family Therapist

Phone

(631) 365-9350

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, and the practitioner matching its NPPES authorized official.

• Jennifer Disomma, LMFT

  • Marriage & Family Therapist
  • Long Island City, NY
  • NPI 1851176358
  NPD Authorized official

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1306412077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3164 21ST ST # 121",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111064573",
            "telephone_number": "631-365-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3164 21ST ST # 121",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111064573",
            "telephone_number": "631-365-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIC MARRIAGE AND FAMILY THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-02",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "DISOMMA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MARRIAGE AND FAMILY THERAPIST",
        "authorized_official_telephone_number": "631-365-9350",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICENSED"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Long Island City, NY
• Providers in Long Island City, NY by specialty
• Marriage & Family Therapist in New York

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