Healthcare Provider Details

I. General information

NPI: 1083341127
Provider Name (Legal Business Name): NISMA, PLLC LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 E 17TH ST
BROOKLYN NY
11230-6010
US

IV. Provider business mailing address

1377 E 17TH ST
BROOKLYN NY
11230-6010
US

V. Phone/Fax

Practice location:
  • Phone: 718-802-8558
  • Fax:
Mailing address:
  • Phone: 917-633-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGIE WASSIF
Title or Position: DIRECTOR
Credential: LCSW
Phone: 917-633-4980