Facts
- Status
- A
- Credential
- LCSW
- Type
- Individual
- Enumeration date
- 2008-05-06
- Last updated
- 2016-10-11
Specialties
Licenses
- License NY
- 077598-1
Location
- Practice location
- 4624 243RD ST
- City
- DOUGLASTON NY
- Postal code
- 113621129
- Phone
- 917-683-8601
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.