Provider Demographics
NPI:1164104873
Name:PRESCOTT, WARDEN (PHD LMSW)
Entity Type:Individual
Prefix:DR
First Name:WARDEN
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:PHD LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E 97TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6923
Mailing Address - Country:US
Mailing Address - Phone:212-814-6081
Mailing Address - Fax:
Practice Address - Street 1:110 E 42ND ST RM 815
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-8538
Practice Address - Country:US
Practice Address - Phone:212-335-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker