Provider Demographics
NPI:1265571582
Name:WILLIAMS COSENTINO, BARBRA (LCSW RN)
Entity type:Individual
Prefix:MS
First Name:BARBRA
Middle Name:
Last Name:WILLIAMS COSENTINO
Suffix:
Gender:F
Credentials:LCSW RN
Other - Prefix:
Other - First Name:BARBRA
Other - Middle Name:WAGNER
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW RN
Mailing Address - Street 1:111 15 75 AVE
Mailing Address - Street 2:#3D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6375
Mailing Address - Country:US
Mailing Address - Phone:718-459-1318
Mailing Address - Fax:
Practice Address - Street 1:111 15 75 AVE
Practice Address - Street 2:SUITE 3D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6375
Practice Address - Country:US
Practice Address - Phone:718-459-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30784R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147501OtherVALUE OPTIONS EMPIRE
NY5387087OtherOXFORD
NY00818Medicare ID - Type Unspecified