Provider Demographics
NPI:1881754430
Name:PREFERRED PROVIDER NETWORK
Entity type:Organization
Organization Name:PREFERRED PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-587-7881
Mailing Address - Street 1:160 BROADWAY
Mailing Address - Street 2:SUITE 603
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4201
Mailing Address - Country:US
Mailing Address - Phone:212-587-7881
Mailing Address - Fax:212-587-7881
Practice Address - Street 1:160 BROADWAY
Practice Address - Street 2:SUITE 603
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4201
Practice Address - Country:US
Practice Address - Phone:212-587-7881
Practice Address - Fax:212-587-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027683-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty