Provider Demographics
NPI:1619936887
Name:KATZENELENBOGEN, ADELE LEW (LCSW)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:LEW
Last Name:KATZENELENBOGEN
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 1:1487 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5144
Mailing Address - Country:US
Mailing Address - Phone:718-377-0423
Mailing Address - Fax:
Practice Address - Street 1:1487 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5144
Practice Address - Country:US
Practice Address - Phone:718-377-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7N701Medicare PIN