Provider Demographics
NPI:1548754708
Name:PAUL, PHILIP HARDING JR (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:HARDING
Last Name:PAUL
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 BROADWAY RM 700
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3257
Mailing Address - Country:US
Mailing Address - Phone:212-966-0466
Mailing Address - Fax:
Practice Address - Street 1:743 E 9TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5335
Practice Address - Country:US
Practice Address - Phone:718-277-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083584-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical