Provider Demographics
NPI:1568639714
Name:BORG, HARUNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HARUNA
Middle Name:
Last Name:BORG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:HARUNA
Other - Middle Name:
Other - Last Name:MIYAMOTO-BORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:530 E 23RD ST
Mailing Address - Street 2:APT9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5022
Mailing Address - Country:US
Mailing Address - Phone:212-978-3257
Mailing Address - Fax:
Practice Address - Street 1:1133 BROADWAY
Practice Address - Street 2:STE 920
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8218
Practice Address - Country:US
Practice Address - Phone:212-978-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076452-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical