Provider Demographics
NPI:1508116328
Name:ZEILICOVICH, DANIEL J (LMSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:ZEILICOVICH
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 1:27 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3823
Mailing Address - Country:US
Mailing Address - Phone:212-242-4140
Mailing Address - Fax:
Practice Address - Street 1:27 BARROW ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3823
Practice Address - Country:US
Practice Address - Phone:212-242-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102370104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080579802Medicaid