Provider Demographics
NPI:1851813836
Name:FOLLINS, LOURDES DOLORES (PH D)
Entity Type:Individual
Prefix:
First Name:LOURDES DOLORES
Middle Name:
Last Name:FOLLINS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 72ND ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1466
Mailing Address - Country:US
Mailing Address - Phone:718-964-7980
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 709
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1107
Practice Address - Country:US
Practice Address - Phone:718-964-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048439-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical