Provider Demographics
NPI:1497079461
Name:BOBB-INNISS, CELINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CELINE
Middle Name:
Last Name:BOBB-INNISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 202ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2530
Mailing Address - Country:US
Mailing Address - Phone:718-264-7803
Mailing Address - Fax:
Practice Address - Street 1:250 FULTON AVE STE 418
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3916
Practice Address - Country:US
Practice Address - Phone:516-858-5001
Practice Address - Fax:646-274-3955
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047220-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical