Provider Demographics
NPI:1215211669
Name:INDEPENDENCE COUNSELING CENTER
Entity type:Organization
Organization Name:INDEPENDENCE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:914-664-0400
Mailing Address - Street 1:10 FISKE PL
Mailing Address - Street 2:205
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3205
Mailing Address - Country:US
Mailing Address - Phone:914-664-0400
Mailing Address - Fax:914-664-0404
Practice Address - Street 1:10 FISKE PL
Practice Address - Street 2:205
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3205
Practice Address - Country:US
Practice Address - Phone:914-664-0400
Practice Address - Fax:914-664-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6383705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty