Healthcare Provider Details

I. General information

NPI: 1609149269
Provider Name (Legal Business Name): MS. NATALIE FORDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

IV. Provider business mailing address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1200
  • Fax: 718-382-3358
Mailing address:
  • Phone: 718-375-1200
  • Fax: 718-382-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: