Provider Demographics
NPI:1629180716
Name:FLECK, DONALD R (LCSW)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:FLECK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6268
Mailing Address - Country:US
Mailing Address - Phone:718-624-4539
Mailing Address - Fax:719-923-9040
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:917-202-5148
Practice Address - Fax:718-923-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-051787-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOG182Medicare ID - Type UnspecifiedMEDICARE ID NUMBER