Healthcare Provider Details

I. General information

NPI: 1063992212
Provider Name (Legal Business Name): JOHN CARLOS ABREU LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 FERRIS PL
BRONX NY
10461-3611
US

IV. Provider business mailing address

100 FISHER AVE STE 412
WHITE PLAINS NY
10606-1919
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-1610
  • Fax:
Mailing address:
  • Phone: 845-600-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: