Provider Demographics
NPI:1225123128
Name:FINE, JEFFREY (LCSW, MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:FINE
Suffix:
Gender:M
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 43RD ST
Mailing Address - Street 2:#1301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4707
Mailing Address - Country:US
Mailing Address - Phone:646-638-9391
Mailing Address - Fax:646-638-9391
Practice Address - Street 1:211 E 43RD ST
Practice Address - Street 2:#1301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:646-638-9391
Practice Address - Fax:646-638-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY44SC046431001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNR7971OtherEMPIRE PROVIDER ID
NYP798244OtherOXFORD PROVIDER ID
NYNR7971Medicare ID - Type UnspecifiedPROVIDER ID