Healthcare Provider Details

I. General information

NPI: 1932153202
Provider Name (Legal Business Name): LOUISA DARATSOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PLACE VA NYH HEALTHCARE SYSTEM BKLYN CAMPUS 122
BROOKLYN NY
11209
US

IV. Provider business mailing address

1139 BAY RIDGE PKWY
BROOKLYN NY
11228
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax:
Mailing address:
  • Phone: 718-836-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR040392-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: