Provider Demographics
NPI:1679343206
Name:EMPOWERING PATHWAYS LCSW PLLC
Entity type:Organization
Organization Name:EMPOWERING PATHWAYS LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BOU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-755-2425
Mailing Address - Street 1:40 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1856
Mailing Address - Country:US
Mailing Address - Phone:917-755-2425
Mailing Address - Fax:
Practice Address - Street 1:40 SURREY LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1856
Practice Address - Country:US
Practice Address - Phone:917-755-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty