Provider Demographics
NPI:1609908524
Name:SOLOMON, DORIS RITA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:RITA
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WEST END AVENUE
Mailing Address - Street 2:APT 10C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6808
Mailing Address - Country:US
Mailing Address - Phone:212-865-8192
Mailing Address - Fax:
Practice Address - Street 1:740 WEST END AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6808
Practice Address - Country:US
Practice Address - Phone:212-865-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147611R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N9A281Medicare ID - Type Unspecified