Provider Demographics
NPI:1851721955
Name:FOUR BRIDGES SOCIAL WORK SERVICES LCSW PC
Entity Type:Organization
Organization Name:FOUR BRIDGES SOCIAL WORK SERVICES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-815-3500
Mailing Address - Street 1:88 NEW DORP PLZ S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2966
Mailing Address - Country:US
Mailing Address - Phone:718-815-3500
Mailing Address - Fax:718-764-6064
Practice Address - Street 1:88 NEW DORP PLZ S
Practice Address - Street 2:SUITE 203
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2966
Practice Address - Country:US
Practice Address - Phone:718-815-3500
Practice Address - Fax:718-764-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0811361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty