Provider Demographics
NPI:1366806705
Name:QUEENS PSYCHOTHERAPY LCSW SERVICES P.C.
Entity type:Organization
Organization Name:QUEENS PSYCHOTHERAPY LCSW SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:718-459-1225
Mailing Address - Street 1:9520 63RD RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1160
Mailing Address - Country:US
Mailing Address - Phone:718-459-1225
Mailing Address - Fax:718-459-5805
Practice Address - Street 1:9520 63RD RD
Practice Address - Street 2:SUITE J
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1160
Practice Address - Country:US
Practice Address - Phone:718-459-1225
Practice Address - Fax:718-459-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty