Healthcare Provider Details

I. General information

NPI: 1699243659
Provider Name (Legal Business Name): LUCJA KOBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 10/24/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BROADWAY FL 2
NEW YORK NY
10013-2562
US

IV. Provider business mailing address

447 BROADWAY # 1317
NEW YORK NY
10013-2562
US

V. Phone/Fax

Practice location:
  • Phone: 646-693-4334
  • Fax:
Mailing address:
  • Phone: 646-693-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: