Provider Demographics
NPI:1578899415
Name:NEW YORK CREATIVE ARTS THERAPISTS PLLC
Entity Type:Organization
Organization Name:NEW YORK CREATIVE ARTS THERAPISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT, LCSW-R
Authorized Official - Phone:917-293-4642
Mailing Address - Street 1:190 N 10TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-9317
Mailing Address - Country:US
Mailing Address - Phone:917-293-4642
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9317
Practice Address - Country:US
Practice Address - Phone:917-293-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077035104100000X
NY0000144221700000X
NY000250221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty