Provider Demographics
NPI:1497190573
Name:FEFFERMAN, ERIC R (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:FEFFERMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 141ST ST
Mailing Address - Street 2:APT. 4B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1674
Mailing Address - Country:US
Mailing Address - Phone:718-961-0839
Mailing Address - Fax:
Practice Address - Street 1:2625 141ST ST
Practice Address - Street 2:APT. 4B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1674
Practice Address - Country:US
Practice Address - Phone:718-961-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker