Provider Demographics
NPI:1043584154
Name:LISTENING CAREFULLY INDIVIDUAL & FAMILY COUNSELING SERVICES
Entity type:Organization
Organization Name:LISTENING CAREFULLY INDIVIDUAL & FAMILY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:718-356-0430
Mailing Address - Street 1:77 OCEANIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6509
Mailing Address - Country:US
Mailing Address - Phone:718-356-0430
Mailing Address - Fax:718-605-7075
Practice Address - Street 1:77 OCEANIC AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6513
Practice Address - Country:US
Practice Address - Phone:718-356-0430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYSR054862320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1902951072OtherPROVIDER NPI