Provider Demographics
NPI:1447879622
Name:ALICE MIRIAM MARJORIE WOODSON WHITE, LCSW, P.C.
Entity type:Organization
Organization Name:ALICE MIRIAM MARJORIE WOODSON WHITE, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MIRIAM MARJORIE
Authorized Official - Last Name:WOODSON WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-352-9735
Mailing Address - Street 1:101 MAIN ST UNIT 2381
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6016
Mailing Address - Country:US
Mailing Address - Phone:631-675-9494
Mailing Address - Fax:631-675-6410
Practice Address - Street 1:249 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2919
Practice Address - Country:US
Practice Address - Phone:631-675-9494
Practice Address - Fax:631-675-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty