Provider Demographics
NPI:1699320721
Name:CIRCLE OF LIFE COUNSELING SERVICES. LCSW, P.C.
Entity type:Organization
Organization Name:CIRCLE OF LIFE COUNSELING SERVICES. LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:516-697-1400
Mailing Address - Street 1:90 SHELTER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1220
Mailing Address - Country:US
Mailing Address - Phone:516-697-1400
Mailing Address - Fax:
Practice Address - Street 1:164 CENTER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1007
Practice Address - Country:US
Practice Address - Phone:516-497-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03518292Medicaid