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Organization
TRI STATE COUNSELING AND MEDIATION LCSW PLLC
Active
Organization
TRI STATE COUNSELING AND MEDIATION LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VASUDEVA CHIKKATUR MURTHY L.C.S.W. (PRESIDENT)
(646) 523-2352
Entity
Organization
Contact information
Practice address
38 W 32ND ST STE 1511, NEW YORK, NY 10001-3875
(917) 215-2169
(801) 708-0844
Mailing address
25403 84TH DR, REGISTERED OFFICE, FLORAL PARK, NY 11001-1009
(646) 523-2352
(801) 708-0844
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
44SC01333400
NJ
1041C0700X
Clinical Social Worker
Primary
R044004-01
NY
1041S0200X
School Social Worker
523650470
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152427
GHI
—
05
—
02861356
—
NY
01
—
16168101
AETNA
NY
01
—
2324784
CIGNA BEHAVIORAL PROVIDER
NY
01
—
37199P
HIP NEW YORK
NY
01
—
579069
VALUE OPTIONS PROVIDER
NY
01
—
R044004
METROPLUS
NY
Enumeration date
10/24/2006
Last updated
06/11/2020
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