Organization
AFFECTIVE LCSW SERVICES PLLC
Active
Organization
AFFECTIVE LCSW SERVICES PLLC
Active
Other names
Affective LCSW Services
Organization subpart
No
Provider details
NPI number
Authorized official
DELSA JOHNSON FAUCONIER LCSW-R (PRESIDENT/CEO)
(347) 788-3775
Entity
Organization
Contact information
Practice address
97 BUSH AVE, STATEN ISLAND, NY 10303-2215
(347) 788-3775
(718) 420-1032
Mailing address
97 BUSH AVE, STATEN ISLAND, NY 10303-2215
(347) 788-3775
(718) 420-1032
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
083062
NY
104100000X
Social Worker
087435
NY
1041C0700X
Clinical Social Worker
Primary
075416
NY
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03546563
—
NY
Enumeration date
12/16/2013
Last updated
08/18/2021
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