Healthcare Provider Details

I. General information

NPI: 1295457455
Provider Name (Legal Business Name): NADIRA AMAURAT PERSAUD LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22219 LINDEN BLVD
JAMAICA NY
11411-1605
US

IV. Provider business mailing address

PO BOX 746087
ATLANTA GA
30374-6087
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-6055
  • Fax: 347-808-4948
Mailing address:
  • Phone: 718-765-6055
  • Fax: 347-808-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100780
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: