Provider Demographics
NPI:1821168923
Name:POWELL, JANICE ROBIN (PHD LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE ROBIN
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W 12TH STREET
Mailing Address - Street 2:#1B OFFICE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-727-3059
Mailing Address - Fax:
Practice Address - Street 1:71 W 12TH ST
Practice Address - Street 2:SUITE 1B OFFICE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-727-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NYR04642111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1106145OtherOXFORD
NYN3C511Medicare PIN