Provider Demographics
NPI:1154876944
Name:LITVACK, CASSIDY (LMHC)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:LITVACK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:LITVACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:509 48TH AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5608
Mailing Address - Country:US
Mailing Address - Phone:516-398-8711
Mailing Address - Fax:
Practice Address - Street 1:275 MADISON AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1144
Practice Address - Country:US
Practice Address - Phone:516-398-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty