Provider Demographics
NPI:1801990189
Name:VASAN, PRABHAKAR (LCSW)
Entity type:Individual
Prefix:MR
First Name:PRABHAKAR
Middle Name:
Last Name:VASAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:PRABU
Other - Middle Name:
Other - Last Name:VASAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:441 W 26 ST
Mailing Address - Street 2:THE HUDSON GUILD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-760-9822
Mailing Address - Fax:212-760-9826
Practice Address - Street 1:441 W 26TH ST RM 122
Practice Address - Street 2:THE HUDSON GUILD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5629
Practice Address - Country:US
Practice Address - Phone:212-760-9822
Practice Address - Fax:212-760-9826
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0695341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3I451Medicare ID - Type Unspecified