Provider Demographics
NPI:1992206775
Name:ANTHONY FREIRE LICENSED MENTAL HEALTH COUNSELOR PLLC
Entity type:Organization
Organization Name:ANTHONY FREIRE LICENSED MENTAL HEALTH COUNSELOR PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-592-2345
Mailing Address - Street 1:2 CHARLTON ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4917
Mailing Address - Country:US
Mailing Address - Phone:917-592-2345
Mailing Address - Fax:
Practice Address - Street 1:96 W HOUSTON ST STE 1F1R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2553
Practice Address - Country:US
Practice Address - Phone:917-592-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty