Healthcare Provider Details

I. General information

NPI: 1902014194
Provider Name (Legal Business Name): DENISE DUBOSE FOULKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 BAISLEY AVE
BRONX NY
10461-6117
US

IV. Provider business mailing address

26 SNIFFEN MOUNTAIN RD
CORTLANDT MANOR NY
10567-6404
US

V. Phone/Fax

Practice location:
  • Phone: 914-734-2205
  • Fax:
Mailing address:
  • Phone: 914-734-2205
  • Fax: 914-734-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR048253-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: