Healthcare Provider Details

I. General information

NPI: 1376296459
Provider Name (Legal Business Name): KARA GRACE FICHTELMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDEN CITY PLZ STE 350
GARDEN CITY NY
11530-3358
US

IV. Provider business mailing address

364 E CHESTER ST
LONG BEACH NY
11561-2325
US

V. Phone/Fax

Practice location:
  • Phone: 516-747-9030
  • Fax:
Mailing address:
  • Phone: 516-554-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098212
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101512-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: