Provider Demographics
NPI:1891914446
Name:PINKERTON, JAY F (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:F
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 BLEECKER ST
Mailing Address - Street 2:#K-31
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2980
Mailing Address - Country:US
Mailing Address - Phone:212-712-2784
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:#1305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:212-712-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049009-11041C0700X
HILCSW-30291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02868922Medicaid
NY02868922Medicaid