Provider Demographics
NPI:1962103523
Name:PHOENIX WITHIN MENTAL HEALTH COUNSELING LLC
Entity type:Organization
Organization Name:PHOENIX WITHIN MENTAL HEALTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICCA-CALDON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-581-2834
Mailing Address - Street 1:775 PARK AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7573
Mailing Address - Country:US
Mailing Address - Phone:917-699-8794
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE STE 255
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7538
Practice Address - Country:US
Practice Address - Phone:917-699-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty