Provider Demographics
NPI:1033356324
Name:INDIVIDUAL AND FAMILY SOCIAL WORK COUSELING
Entity Type:Organization
Organization Name:INDIVIDUAL AND FAMILY SOCIAL WORK COUSELING
Other - Org Name:KINGSBORO PSYCHIATRIC CENTER (CANARSIE OPD CLINIC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:718-703-2027
Mailing Address - Street 1:180 LENOX RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2486
Mailing Address - Country:US
Mailing Address - Phone:718-703-2027
Mailing Address - Fax:718-940-0054
Practice Address - Street 1:180 LENOX RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2486
Practice Address - Country:US
Practice Address - Phone:718-703-2027
Practice Address - Fax:718-940-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health