Provider Demographics
NPI:1962644823
Name:PABON, EDDIE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:
Last Name:PABON
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 1:3121 MIDDLETOWN RD APT 4N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5318
Mailing Address - Country:US
Mailing Address - Phone:917-751-5596
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST APT 6C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8922
Practice Address - Country:US
Practice Address - Phone:917-751-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker