Healthcare Provider Details

I. General information

NPI: 1154756427
Provider Name (Legal Business Name): MIMI OGAWA-SPIGLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 FLUSHING AVE APT 216
BROOKLYN NY
11237-1823
US

IV. Provider business mailing address

1087 FLUSHING AVE APT 216
BROOKLYN NY
11237-1823
US

V. Phone/Fax

Practice location:
  • Phone: 646-287-7271
  • Fax:
Mailing address:
  • Phone: 646-287-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number079902
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086277-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: