Provider Demographics
NPI:1790482156
Name:WITKES LCSW PC
Entity Type:Organization
Organization Name:WITKES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOSEF
Authorized Official - Middle Name:ZEV
Authorized Official - Last Name:WITKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:216-600-7278
Mailing Address - Street 1:1154 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2607
Mailing Address - Country:US
Mailing Address - Phone:216-600-7278
Mailing Address - Fax:
Practice Address - Street 1:1154 STERLING PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2607
Practice Address - Country:US
Practice Address - Phone:216-600-7278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06303906Medicaid