Provider Demographics
NPI:1417637042
Name:LW NP PSYCHIATRY PC
Entity Type:Organization
Organization Name:LW NP PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAVERN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-244-3196
Mailing Address - Street 1:1057 EASTERN PKWY APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:142 JORALEMON ST RM 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4747
Practice Address - Country:US
Practice Address - Phone:646-244-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty