Healthcare Provider Details

I. General information

NPI: 1548334451
Provider Name (Legal Business Name): TADDEE MISZKIEL LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TADDEE MISSRAN

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

17 RUSSELL RD
HAMPTON BAYS NY
11946-2461
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax: 212-477-0521
Mailing address:
  • Phone: 917-583-5020
  • Fax: 212-477-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: