Provider Demographics
NPI:1730911876
Name:EMILIE K PSYCHOTHERAPY LCSW PLLC
Entity type:Organization
Organization Name:EMILIE K PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-399-6755
Mailing Address - Street 1:90 BROAD ST RM 1038
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2205
Mailing Address - Country:US
Mailing Address - Phone:929-399-6755
Mailing Address - Fax:
Practice Address - Street 1:90 BROAD ST RM 1038
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2205
Practice Address - Country:US
Practice Address - Phone:929-399-6755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)