Provider Demographics
NPI:1639713845
Name:BORR, NATHAN (MFT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BORR
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:NISSAN
Other - Middle Name:
Other - Last Name:BORR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1955 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1955 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1805
Practice Address - Country:US
Practice Address - Phone:718-787-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor