Provider Demographics
NPI:1073874186
Name:HATTAB, WARDEH CARLOS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WARDEH
Middle Name:CARLOS
Last Name:HATTAB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W 26TH ST FL 8
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6700
Mailing Address - Country:US
Mailing Address - Phone:937-771-1037
Mailing Address - Fax:
Practice Address - Street 1:226 W 26TH ST FL 8
Practice Address - Street 2:SUITE 12
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6700
Practice Address - Country:US
Practice Address - Phone:937-771-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0846311041C0700X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No283Q00000XHospitalsPsychiatric Hospital