Provider Demographics
NPI:1124626692
Name:HYACINTH LCSW SERVICES P.C.
Entity type:Organization
Organization Name:HYACINTH LCSW SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANTIONETTE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCSW
Authorized Official - Phone:917-561-6321
Mailing Address - Street 1:222 N BROADWAY APT 5C
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2617
Mailing Address - Country:US
Mailing Address - Phone:917-561-6321
Mailing Address - Fax:
Practice Address - Street 1:222 N BROADWAY APT 5C
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2617
Practice Address - Country:US
Practice Address - Phone:917-561-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty