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NPI Code Detail

MEDICARE: HER BLACK THERAPIST LCSW P.C.

MEDICARE: HER BLACK THERAPIST LCSW P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3104100000XSocial Worker
41041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457973539
Entity Type Code : Organization
Provider Name (Legal Business Name) : HER BLACK THERAPIST LCSW P.C.
Provider Business Mailing Address
First Line : 1080 BERGEN ST STE 122
Second Line :
City : BROOKLYN
State : NY
Zip : 11216-3340
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1080 BERGEN ST STE 122
Second Line :
City : BROOKLYN
State : NY
Zip : 11216-3340
Country : US
Telephone Number : 929-429-4733
Fax Number :
Authorized Official
Title or Position : OWNER/ CEO
Name : KALISHA SMITH
Credential : LCSW CASAC
Telephone Number : 929-429-4733
Provider Enumeration Date : 05/12/2020
Last Update Date : 01/19/2021

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Directions to “HER BLACK THERAPIST LCSW P.C. ” Practice Location

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