Healthcare Provider Details

I. General information

NPI: 1053017855
Provider Name (Legal Business Name): KIRSTEN MEGHAN DAGROSA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 11/15/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 DEAN ST FL 1
BROOKLYN NY
11238-3303
US

IV. Provider business mailing address

402 PARK PL
BROOKLYN NY
11238-4002
US

V. Phone/Fax

Practice location:
  • Phone: 929-548-2339
  • Fax:
Mailing address:
  • Phone: 347-563-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: