Provider Demographics
NPI:1972686913
Name:HALL, PUJA BRIGITTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PUJA
Middle Name:BRIGITTE
Last Name:HALL
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 1:900 W END AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3538
Mailing Address - Country:US
Mailing Address - Phone:212-665-7352
Mailing Address - Fax:631-907-2635
Practice Address - Street 1:900 W END AVE APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3538
Practice Address - Country:US
Practice Address - Phone:212-665-7352
Practice Address - Fax:631-907-2635
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050285-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN735R1Medicare ID - Type UnspecifiedMENTAL HEALTH