Healthcare Provider Details

I. General information

NPI: 1598319527
Provider Name (Legal Business Name): TETE DUMBO LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 JAY ST STE 409
BROOKLYN NY
11201-8361
US

IV. Provider business mailing address

68 JAY ST STE 409
BROOKLYN NY
11201-8361
US

V. Phone/Fax

Practice location:
  • Phone: 646-477-4912
  • Fax:
Mailing address:
  • Phone: 646-477-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOEY ACKERMAN
Title or Position: PSYCHOTHERAPIST
Credential: LCSW-R
Phone: 917-559-0735