1215459920 NPI number — SOCIAL BUTTERFLIES PSYCHOTHERAPY LCSW PLLC

Table of content: (NPI 1215459920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215459920 NPI number — SOCIAL BUTTERFLIES PSYCHOTHERAPY LCSW PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOCIAL BUTTERFLIES PSYCHOTHERAPY LCSW PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215459920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7405 METROPOLITAN AVE STE 2F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLE VILLAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11379-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-773-7637
Provider Business Mailing Address Fax Number:
718-228-2845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7405 METROPOLITAN AVE STE 2F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLE VILLAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11379-2699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-773-7637
Provider Business Practice Location Address Fax Number:
718-228-2845
Provider Enumeration Date:
07/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
OVIEDO
Authorized Official First Name:
LUZ
Authorized Official Middle Name:
MARIEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
917-773-7637

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  079283 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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