Provider Demographics
NPI:1558017855
Name:LOUIS, MARDOCHEE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARDOCHEE
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SUYDAM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3309
Mailing Address - Country:US
Mailing Address - Phone:934-852-0671
Mailing Address - Fax:
Practice Address - Street 1:164 SUYDAM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3309
Practice Address - Country:US
Practice Address - Phone:934-852-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker