Provider Demographics
NPI:1073392932
Name:VILD, ALBERT JAMES (LMSW)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JAMES
Last Name:VILD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3317
Mailing Address - Country:US
Mailing Address - Phone:646-573-0948
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0977
Practice Address - Country:US
Practice Address - Phone:646-573-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
NY121169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical