Provider Demographics
NPI:1902376072
Name:POWELL, AKIRA (LMSW)
Entity Type:Individual
Prefix:
First Name:AKIRA
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FORT HILL PARK
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1702
Mailing Address - Country:US
Mailing Address - Phone:347-781-6619
Mailing Address - Fax:
Practice Address - Street 1:30 FORT HILL PARK
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1702
Practice Address - Country:US
Practice Address - Phone:347-781-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker