Provider Demographics
NPI:1922166990
Name:VALE, KENNETH MARTIN (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MARTIN
Last Name:VALE
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 DEGRAW ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2948
Mailing Address - Country:US
Mailing Address - Phone:718-625-1860
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 712
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:917-685-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0586471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY157415POtherHIP
NYP2199099OtherOXFORD
NY157415POtherHIP