Healthcare Provider Details

I. General information

NPI: 1922188796
Provider Name (Legal Business Name): CAMY RACHEL MIZRAHI CHIRAZI L.M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 53RD ST
BROOKLYN NY
11219-3820
US

IV. Provider business mailing address

2046 E 23RD ST
BROOKLYN NY
11229-3644
US

V. Phone/Fax

Practice location:
  • Phone: 718-435-5700
  • Fax:
Mailing address:
  • Phone: 718-646-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0619961
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: