Provider Demographics
NPI:1447078480
Name:REVIVE PSYCHO THERAPY LLC
Entity type:Organization
Organization Name:REVIVE PSYCHO THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-623-9554
Mailing Address - Street 1:90 VERMILYEA AVE UNIT 428
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-9417
Mailing Address - Country:US
Mailing Address - Phone:646-316-4902
Mailing Address - Fax:
Practice Address - Street 1:2800 PARKVIEW TER APT 5A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1532
Practice Address - Country:US
Practice Address - Phone:646-316-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty