Healthcare Provider Details

I. General information

NPI: 1467625400
Provider Name (Legal Business Name): SIMCHA FEUERMAN LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 69TH RD
FLUSHING NY
11367-1732
US

IV. Provider business mailing address

14732 69TH RD
FLUSHING NY
11367-1732
US

V. Phone/Fax

Practice location:
  • Phone: 718-793-1376
  • Fax: 718-686-4275
Mailing address:
  • Phone: 718-793-1376
  • Fax: 718-686-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number047809
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: