1326709239 NPI number — CRECER COUNSELING SERVICES LCSW PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326709239 NPI number — CRECER COUNSELING SERVICES LCSW PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRECER COUNSELING SERVICES LCSW PC
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:
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:
1326709239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-642-4086
Provider Business Mailing Address Fax Number:
631-888-0431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 61ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11377-5766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-642-4086
Provider Business Practice Location Address Fax Number:
631-888-0431
Provider Enumeration Date:
01/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
IMBERTI
Authorized Official First Name:
PRISKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-889-3417

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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