# HISPANIC THERAPY SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245785005
- **Authorized official:** MR. RAFAEL ERIC BOU L.C.S.W. (PSYCHOTHERAPIST)
- **Authorized official phone:** (917) 755-2425

## Contact information

- **Practice address:** 26 ROOSEVELT CT, WESTBURY, NY 11590-4135
- **Practice address phone:** (917) 755-2425
- **Mailing address:** 26 ROOSEVELT CT, WESTBURY, NY 11590-4135
- **Mailing address phone:** (917) 755-2425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 081037-1 | NY | Yes |

## Other

- **Enumeration date:** 08/22/2016
- **Last updated:** 08/22/2016