Healthcare Provider Details

I. General information

NPI: 1891318903
Provider Name (Legal Business Name): HARVEY RAY OGUN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 E 29TH ST APT 1
BROOKLYN NY
11229-5056
US

IV. Provider business mailing address

2207 E 29TH ST APT 1
BROOKLYN NY
11229-5056
US

V. Phone/Fax

Practice location:
  • Phone: 717-576-4583
  • Fax:
Mailing address:
  • Phone: 717-576-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096552
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: