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Organization
CLINICAL, CONSULTATION AND SUPERVISION SERVICES LCSW PLLC
Active
Organization
CLINICAL, CONSULTATION AND SUPERVISION SERVICES LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOMINIQUE NERESTAN LCSW-R (CLINICAL SOCIAL WORKER)
(917) 653-8972
Entity
Organization
Contact information
Practice address
3510 BAINBRIDGE AVE APT S1, BRONX, NY 10467-1419
(917) 653-8972
(888) 812-4062
Mailing address
319 TONETTA LAKE RD, BREWSTER, NY 10509-4134
(845) 893-4948
(888) 812-4062
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R063179
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R063179
NYS LICENSE
NY
Enumeration date
09/20/2012
Last updated
01/08/2013
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