Healthcare Provider Details

I. General information

NPI: 1023159167
Provider Name (Legal Business Name): DEIRDRE A. COLE LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 SMITH AVE
MOUNT KISCO NY
10549-2814
US

IV. Provider business mailing address

42 SMITH AVE
MOUNT KISCO NY
10549-2814
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-0890
  • Fax:
Mailing address:
  • Phone: 914-242-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR040-730-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: