Healthcare Provider Details

I. General information

NPI: 1396151528
Provider Name (Legal Business Name): LLOYD FIDER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W 34TH ST FL 17
NEW YORK NY
10120
US

IV. Provider business mailing address

112 W 34TH ST FL 17
NEW YORK NY
10120-0001
US

V. Phone/Fax

Practice location:
  • Phone: 516-660-0025
  • Fax: 718-744-9755
Mailing address:
  • Phone: 516-660-0025
  • Fax: 718-744-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: