Long Island City Psychotherapy Services LCSW, PC

Primary specialty

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

License

R006721 Issued in NY

Legal business name

LONG ISLAND CITY PSYCHOTHERAPY SERVICES LCSW, PC

Practice address

301 27TH Ave
Long Island City, NY 11102-4616

Phone

(718) 721-0606

Fax

(718) 204-5481

NPI assigned

Apr 25, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Muriel Dethomas, LCSW

Title

President

Phone

(718) 721-0606

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1669730826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 27TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111024616",
            "telephone_number": "718-721-0606",
            "fax_number": "718-204-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 27TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111024616",
            "telephone_number": "718-721-0606",
            "fax_number": "718-204-5481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND CITY PSYCHOTHERAPY SERVICES LCSW, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "DETHOMAS",
        "authorized_official_first_name": "MURIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-721-0606",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NY",
            "license": "R006721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Long Island City, NY
• Providers in Long Island City, 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 Apr 25, 2012; 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.