Provider Demographics
NPI:1629288592
Name:PRENGEL, SERGE L (LMHC)
Entity Type:Individual
Prefix:MR
First Name:SERGE
Middle Name:L
Last Name:PRENGEL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIVERSIDE DR
Mailing Address - Street 2:# 18 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6172
Mailing Address - Country:US
Mailing Address - Phone:212-337-3737
Mailing Address - Fax:
Practice Address - Street 1:60 RIVERSIDE DR
Practice Address - Street 2:# 18 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6172
Practice Address - Country:US
Practice Address - Phone:212-337-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000574102L00000X
NY003438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
870774850OtherTIN