Provider Demographics
NPI:1417313206
Name:PRASAD, REKA (LMSW)
Entity Type:Individual
Prefix:
First Name:REKA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PARK AVE
Mailing Address - Street 2:#6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 THOMPSON ST
Practice Address - Street 2:ROOM 283
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1020
Practice Address - Country:US
Practice Address - Phone:917-494-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087254-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker