Healthcare Provider Details

I. General information

NPI: 1427297167
Provider Name (Legal Business Name): EVA ISMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 BUSHWICK AVE
BROOKLYN NY
11207-1422
US

IV. Provider business mailing address

751 WESTMINSTER RD
BROOKLYN NY
11230-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-1000
  • Fax: 718-602-1111
Mailing address:
  • Phone: 347-256-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number034121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: