Healthcare Provider Details

I. General information

NPI: 1740652908
Provider Name (Legal Business Name): HASAN ALI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W 4TH ST
DEER PARK NY
11729-5114
US

IV. Provider business mailing address

202 W 4TH ST
DEER PARK NY
11729-5114
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-5235
  • Fax:
Mailing address:
  • Phone: 718-576-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: