Healthcare Provider Details

I. General information

NPI: 1134897192
Provider Name (Legal Business Name): CYRUS HUANG LMSW, MS ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MONTGOMERY ST
NEW YORK NY
10002-4808
US

IV. Provider business mailing address

158 7TH AVE APT 4R
BROOKLYN NY
11215-2244
US

V. Phone/Fax

Practice location:
  • Phone: 212-766-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110324
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: