Provider Demographics
NPI:1740876192
Name:MEHALEK, KEVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MEHALEK
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 1:16 MAUJER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-7622
Mailing Address - Country:US
Mailing Address - Phone:708-203-0529
Mailing Address - Fax:
Practice Address - Street 1:1751 2ND AVE STE AZ-5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5363
Practice Address - Country:US
Practice Address - Phone:914-342-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107064104100000X
NY0952251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker