Healthcare Provider Details

I. General information

NPI: 1619367059
Provider Name (Legal Business Name): AVIGAIL HURVITZ-PRINZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 CLINTON AVE APT 2C
BROOKLYN NY
11205-2354
US

IV. Provider business mailing address

149 CLINTON AVE APT 2C
BROOKLYN NY
11205-2354
US

V. Phone/Fax

Practice location:
  • Phone: 917-848-8811
  • Fax:
Mailing address:
  • Phone: 917-848-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093505-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: