| Live Well Psychotherapy Lcsw Pllc | |
|
100 Broadhollow Rd Ste 108 Farmingdale NY 11735-4813 | |
| (631) 769-7763 | |
| (631) 769-7763 |
| Full Name | Live Well Psychotherapy Lcsw Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 100 Broadhollow Rd Ste 108, Farmingdale, New York |
| Authorized Official Name and Position | Carmen R Ceballos (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 6317697763 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Psychotherapy Lcsw Pllc 26 Wilson Ave Deer Park NY 11729-6714 Ph: (646) 932-6759 | Live Well Psychotherapy Lcsw Pllc 100 Broadhollow Rd Ste 108 Farmingdale NY 11735-4813 Ph: (631) 769-7763 |
| NPI Number | 1245995372 |
|---|---|
| Provider Enumeration Date | 11/03/2021 |
| Last Update Date | 12/06/2021 |
| Certification Date | 12/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245995372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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