Provider Demographics
NPI:1013088210
Name:BORGIDA, MITCHELL CRAIG (LCSW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:CRAIG
Last Name:BORGIDA
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 1:177 E 87TH ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2226
Mailing Address - Country:US
Mailing Address - Phone:212-879-0357
Mailing Address - Fax:212-879-0357
Practice Address - Street 1:154 E 71ST ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5125
Practice Address - Country:US
Practice Address - Phone:212-879-0357
Practice Address - Fax:212-879-0357
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0344101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN57401Medicare ID - Type Unspecified