Healthcare Provider Details

I. General information

NPI: 1790486280
Provider Name (Legal Business Name): SEETA KOARLALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2876 W 17TH ST
BROOKLYN NY
11224-2612
US

IV. Provider business mailing address

13302 LEFFERTS BLVD
SOUTH OZONE PARK NY
11420-3130
US

V. Phone/Fax

Practice location:
  • Phone: 914-308-0395
  • Fax:
Mailing address:
  • Phone: 646-266-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117875-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: