Provider Demographics
NPI:1265221030
Name:INDIVIDUALIZED PSYCHOTHERAPY MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:INDIVIDUALIZED PSYCHOTHERAPY MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAGLA
Authorized Official - Middle Name:HADY
Authorized Official - Last Name:RADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:347-603-0291
Mailing Address - Street 1:167 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3200
Mailing Address - Country:US
Mailing Address - Phone:347-603-0291
Mailing Address - Fax:
Practice Address - Street 1:167 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3200
Practice Address - Country:US
Practice Address - Phone:347-603-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty