Healthcare Provider Details

I. General information

NPI: 1366931487
Provider Name (Legal Business Name): TATIANA ALESSE TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N 4TH ST OFC 2168
BROOKLYN NY
11249-3296
US

IV. Provider business mailing address

1775 GRAND CONCOURSE
BRONX NY
10453-8202
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-7748
  • Fax:
Mailing address:
  • Phone: 212-560-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102145
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0135226
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: