Provider Demographics
NPI:1992113369
Name:HEART AND SOUL LCSW P.C.
Entity type:Organization
Organization Name:HEART AND SOUL LCSW P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-419-9962
Mailing Address - Street 1:37 MAHOPAC AVE
Mailing Address - Street 2:
Mailing Address - City:AMAWALK
Mailing Address - State:NY
Mailing Address - Zip Code:10501-1004
Mailing Address - Country:US
Mailing Address - Phone:914-419-9962
Mailing Address - Fax:
Practice Address - Street 1:220 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-3850
Practice Address - Country:US
Practice Address - Phone:914-419-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038276-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization