Provider Demographics
NPI:1619106358
Name:TOLBERT, PAGE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAGE
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 E 84TH ST
Mailing Address - Street 2:APARTMENT 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7338
Mailing Address - Country:US
Mailing Address - Phone:212-861-8642
Mailing Address - Fax:
Practice Address - Street 1:115 E 82ND ST STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0828
Practice Address - Country:US
Practice Address - Phone:917-612-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0355071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9L351Medicare PIN