| Common Practice Counseling Lcsw Pllc | |
|
21 Georgia Street Valley Stream NY 11580-2224 | |
| (718) 415-2678 | |
| (718) 481-7609 |
| Full Name | Common Practice Counseling Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 21 Georgia Street, Valley Stream, New York |
| Authorized Official Name and Position | Michelle Scantlebury (PRACTICE OWNER) |
| Authorized Official Contact | 7184152678 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Common Practice Counseling Lcsw Pllc 21 Georgia Street Valley Stream NY 11580-2224 Ph: (718) 415-2678 | Common Practice Counseling Lcsw Pllc 21 Georgia Street Valley Stream NY 11580-2224 Ph: (718) 415-2678 |
| NPI Number | 1710558879 |
|---|---|
| Provider Enumeration Date | 07/08/2021 |
| Last Update Date | 03/01/2024 |
| Certification Date | 03/01/2024 |
| Medicare PECOS PAC ID | 3173914991 |
|---|---|
| Medicare Enrollment ID | O20220104002765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710558879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michelle O Scantlebury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033448535 PECOS PAC ID: 6103051271 Enrollment ID: I20131025000565 |
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