Provider Demographics
NPI:1275886871
Name:NATHANSON, DONALD FREDERICKS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:FREDERICKS
Last Name:NATHANSON
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 1:600 MAMARONECK AVENUE
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528
Mailing Address - Country:US
Mailing Address - Phone:310-418-8200
Mailing Address - Fax:
Practice Address - Street 1:600 MAMARONECK AVENUE
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528
Practice Address - Country:US
Practice Address - Phone:310-418-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0837371041C0700X
NJ44SC056538001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical