Healthcare Provider Details

I. General information

NPI: 1558838292
Provider Name (Legal Business Name): EZRIEL D DEUTSCH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

IV. Provider business mailing address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

V. Phone/Fax

Practice location:
  • Phone: 718-954-3800
  • Fax:
Mailing address:
  • Phone: 718-954-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093539-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: