Provider Demographics
NPI:1881260529
Name:EDDIE PABON, LCSW, PLLC
Entity type:Organization
Organization Name:EDDIE PABON, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-751-5596
Mailing Address - Street 1:3121 MIDDLETOWN RD APT 4N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5318
Mailing Address - Country:US
Mailing Address - Phone:917-751-5596
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST APT 6C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8922
Practice Address - Country:US
Practice Address - Phone:917-751-5596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962644823OtherNPI
NY080720OtherLCSW LICENSE NUMBER