| Mobile Counseling Of New York Lcsw, Pllc | |
|
52 Woodstream Dr Grand Island NY 14072-1485 | |
| (716) 302-4545 | |
| Not Available |
| Full Name | Mobile Counseling Of New York Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 52 Woodstream Dr, Grand Island, New York |
| Authorized Official Name and Position | Nino Elizondo (OWNER) |
| Authorized Official Contact | 7163024545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Counseling Of New York Lcsw, Pllc 52 Woodstream Dr Grand Island NY 14072-1485 Ph: (716) 302-4545 | Mobile Counseling Of New York Lcsw, Pllc 52 Woodstream Dr Grand Island NY 14072-1485 Ph: (716) 302-4545 |
| NPI Number | 1700359700 |
|---|---|
| Provider Enumeration Date | 01/02/2019 |
| Last Update Date | 03/12/2020 |
| Certification Date | 03/12/2020 |
| Medicare PECOS PAC ID | 9234548710 |
|---|---|
| Medicare Enrollment ID | O20210513001278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700359700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nino A Elizondo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164608188 PECOS PAC ID: 9537496104 Enrollment ID: I20210624000225 |
| Provider Name | Colby Enides |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952800468 PECOS PAC ID: 9739564691 Enrollment ID: I20220914001251 |
| Provider Name | Nikki Anne Harrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407250293 PECOS PAC ID: 0446636229 Enrollment ID: I20220930002581 |
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