| New York Counseling For Change, Llc | |
|
3046 Northern Blvd Long Island City NY 11101-2816 | |
| (718) 424-6191 | |
| (212) 896-6530 |
| Full Name | New York Counseling For Change, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3046 Northern Blvd, Long Island City, New York |
| Authorized Official Name and Position | Lawrence Menzie (OWNER) |
| Authorized Official Contact | 9174943281 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New York Counseling For Change, Llc 12333 83rd Ave Apt 705 Kew Gardens NY 11415-3435 Ph: (917) 494-3281 | New York Counseling For Change, Llc 3046 Northern Blvd Long Island City NY 11101-2816 Ph: (718) 424-6191 |
| NPI Number | 1104456649 |
|---|---|
| Provider Enumeration Date | 01/23/2020 |
| Last Update Date | 01/23/2020 |
| Certification Date | 01/23/2020 |
| Medicare PECOS PAC ID | 6709216096 |
|---|---|
| Medicare Enrollment ID | O20200429002033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104456649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Larry Menzie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972744423 PECOS PAC ID: 2769633767 Enrollment ID: I20121126000468 |
| Provider Name | Beth Covelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760529788 PECOS PAC ID: 3375834088 Enrollment ID: I20160627001770 |
| Provider Name | Antoinette Jones-perrin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205263555 PECOS PAC ID: 7315338332 Enrollment ID: I20211230001950 |
| Provider Name | Eva Sharpe Pollock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053055129 PECOS PAC ID: 4183093735 Enrollment ID: I20221205000162 |
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