Provider Demographics
NPI:1104456649
Name:NEW YORK COUNSELING FOR CHANGE, LLC
Entity type:Organization
Organization Name:NEW YORK COUNSELING FOR CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-494-3281
Mailing Address - Street 1:12333 83RD AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3435
Mailing Address - Country:US
Mailing Address - Phone:917-494-3281
Mailing Address - Fax:
Practice Address - Street 1:3046 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2816
Practice Address - Country:US
Practice Address - Phone:718-424-6191
Practice Address - Fax:212-896-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)