Provider Demographics
NPI:1679186092
Name:HERASME, DAVID (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:HERASME
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PELHAM PKWY S RM 8E21
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1119
Mailing Address - Country:US
Mailing Address - Phone:718-918-6676
Mailing Address - Fax:718-918-6732
Practice Address - Street 1:1400 PELHAM PKWY S # 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1119
Practice Address - Country:US
Practice Address - Phone:718-918-6676
Practice Address - Fax:718-918-6732
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0821541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical