Healthcare Provider Details

I. General information

NPI: 1558410662
Provider Name (Legal Business Name): MARK IAN FRANK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 JAMAICA AVE
JAMAICA NY
11435-4042
US

IV. Provider business mailing address

51 LOCUST AVE
CEDARHURST NY
11516-2313
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax: 718-297-8658
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070252-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: