Provider Demographics
NPI:1568292506
Name:POSITIVE PATHWAY LCSW PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:POSITIVE PATHWAY LCSW PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-850-2795
Mailing Address - Street 1:191 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5610
Mailing Address - Country:US
Mailing Address - Phone:516-850-2795
Mailing Address - Fax:
Practice Address - Street 1:191 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5610
Practice Address - Country:US
Practice Address - Phone:516-850-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)