Provider Demographics
NPI:1558618447
Name:FLORES, FRED (LMSW)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:FLORES
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 1:1437 1ST AVE
Mailing Address - Street 2:4FN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3334
Mailing Address - Country:US
Mailing Address - Phone:646-382-8028
Mailing Address - Fax:
Practice Address - Street 1:1437 1ST AVE
Practice Address - Street 2:4FN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3334
Practice Address - Country:US
Practice Address - Phone:646-382-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049720-1101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor