Provider Demographics
NPI:1467480988
Name:KOFF, TERI (LCSW, CMC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:KOFF
Suffix:
Gender:F
Credentials:LCSW, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 YORK AVE
Mailing Address - Street 2:6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4030
Mailing Address - Country:US
Mailing Address - Phone:212-737-0277
Mailing Address - Fax:
Practice Address - Street 1:1360 YORK AVE
Practice Address - Street 2:6H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4030
Practice Address - Country:US
Practice Address - Phone:212-737-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR021145-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN51351Medicare ID - Type UnspecifiedSOCIAL WORK