Provider Demographics
NPI:1235140435
Name:FLICK, ROBERT JAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAY
Last Name:FLICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 15TH ST
Mailing Address - Street 2:APT 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3723
Mailing Address - Country:US
Mailing Address - Phone:917-747-5595
Mailing Address - Fax:212-260-2757
Practice Address - Street 1:201 E 15TH ST
Practice Address - Street 2:APT 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3729
Practice Address - Country:US
Practice Address - Phone:212-947-7111
Practice Address - Fax:212-260-2757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-014144-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY515096Medicare UPIN
NYN39931Medicare ID - Type Unspecified