Provider Demographics
NPI:1972089795
Name:DROGOUL BICKSON, CONSTANCE JOAN (LMSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JOAN
Last Name:DROGOUL BICKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:JOAN
Other - Last Name:DROGOUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:195 MONTAGUE ST UNIT K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3628
Mailing Address - Country:US
Mailing Address - Phone:718-488-0100
Mailing Address - Fax:
Practice Address - Street 1:195 MONTAGUE ST UNIT K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3628
Practice Address - Country:US
Practice Address - Phone:718-488-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102232104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker