Healthcare Provider Details

I. General information

NPI: 1356162960
Provider Name (Legal Business Name): WOVEN THREADS PSYCHOTHERAPY LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CADMAN PLAZA WEST 12TH FLOOR - #5025
BROOKLYN NY
11201
US

IV. Provider business mailing address

1626 E 51ST ST
BROOKLYN NY
11234-3822
US

V. Phone/Fax

Practice location:
  • Phone: 646-470-8787
  • Fax:
Mailing address:
  • Phone: 646-470-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. HEBAH KHALIFA
Title or Position: MEMBER-MANAGER
Credential: PH.D., MSW
Phone: 646-470-8787