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Organization
LIVE WELL PSYCHOTHERAPY LCSW PLLC
Active
Organization
LIVE WELL PSYCHOTHERAPY LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARMEN R CEBALLOS LCSW-R (OWNER/PSYCHOTHERAPIST)
(631) 769-7763
Entity
Organization
Contact information
Practice address
100 BROADHOLLOW RD STE 108, FARMINGDALE, NY 11735-4813
(631) 769-7763
(631) 769-7763
Mailing address
26 WILSON AVE, DEER PARK, NY 11729-6714
(646) 932-6759
(631) 769-7763
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/03/2021
Last updated
12/06/2021
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