Provider Demographics
NPI:1245941780
Name:AFFIRMATIVE THERAPY LCSW PLLC
Entity type:Organization
Organization Name:AFFIRMATIVE THERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANONICO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-470-1163
Mailing Address - Street 1:80 UNIVERSITY PL FL 2G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4564
Mailing Address - Country:US
Mailing Address - Phone:646-470-1163
Mailing Address - Fax:
Practice Address - Street 1:80 UNIVERSITY PL FL 2G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4564
Practice Address - Country:US
Practice Address - Phone:646-470-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty