Provider Demographics
NPI:1902014194
Name:FOULKES, DENISE DUBOSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:DUBOSE
Last Name:FOULKES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SNIFFEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6404
Mailing Address - Country:US
Mailing Address - Phone:914-734-2205
Mailing Address - Fax:914-734-2203
Practice Address - Street 1:2880 BAISLEY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6117
Practice Address - Country:US
Practice Address - Phone:914-734-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048253-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN67921Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER