Provider Demographics
NPI:1750191292
Name:NASSER, EBTESAM
Entity type:Individual
Prefix:
First Name:EBTESAM
Middle Name:
Last Name:NASSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 LENOX AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4991
Mailing Address - Country:US
Mailing Address - Phone:212-289-1788
Mailing Address - Fax:315-332-9497
Practice Address - Street 1:290 LENOX AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4991
Practice Address - Country:US
Practice Address - Phone:212-289-1788
Practice Address - Fax:315-332-9497
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool