Provider Demographics
NPI:1740626936
Name:GEORGE, DOUGLAS W (LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:W
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STERLING PL APT 1I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3324
Mailing Address - Country:US
Mailing Address - Phone:646-820-4269
Mailing Address - Fax:646-354-7663
Practice Address - Street 1:26 COURT ST STE 1009
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1110
Practice Address - Country:US
Practice Address - Phone:646-820-4269
Practice Address - Fax:646-354-7663
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086839104100000X
NY0852151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker