1831789957 NPI number — ORCHARD BLUE COUNSELING SERVICES LCSW, PLLC

Table of content: (NPI 1831789957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831789957 NPI number — ORCHARD BLUE COUNSELING SERVICES LCSW, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORCHARD BLUE COUNSELING SERVICES 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:
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:
1831789957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19019 LINDEN BLVD STE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11412-3361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-200-1174
Provider Business Mailing Address Fax Number:
929-529-7453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19019 LINDEN BLVD STE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11412-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-200-1174
Provider Business Practice Location Address Fax Number:
929-529-7453
Provider Enumeration Date:
01/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
CERENE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official Telephone Number:
516-341-2727

Provider Taxonomy Codes

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

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

  • Identifier: 05971531 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700397494 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1700397494 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1700397494 . This is a "OPTUM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1700397494 . This is a "BEACON HEALTH OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1700397494 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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