Provider Demographics
NPI:1336435684
Name:FORTIER, ADOLFO (LMSW)
Entity Type:Individual
Prefix:
First Name:ADOLFO
Middle Name:
Last Name:FORTIER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 78TH STREET
Mailing Address - Street 2:APARTMENT 619
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1975
Mailing Address - Country:US
Mailing Address - Phone:917-774-8593
Mailing Address - Fax:
Practice Address - Street 1:4045 75TH STREET 2FL
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-505-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0772921104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker