Provider Demographics
NPI:1780838060
Name:PLAYDATE LMSW SOCIAL WORK PLLC
Entity Type:Organization
Organization Name:PLAYDATE LMSW SOCIAL WORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:917-863-3780
Mailing Address - Street 1:208 W 119TH ST
Mailing Address - Street 2:SUITE 3R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1209
Mailing Address - Country:US
Mailing Address - Phone:917-863-3780
Mailing Address - Fax:646-596-7791
Practice Address - Street 1:208 W 119TH ST
Practice Address - Street 2:SUITE 3R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1209
Practice Address - Country:US
Practice Address - Phone:917-863-3780
Practice Address - Fax:646-596-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061668-1261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health