Healthcare Provider Details

I. General information

NPI: 1073805354
Provider Name (Legal Business Name): DENISE E TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 MADISON AVE
NEW YORK NY
10035-3832
US

IV. Provider business mailing address

CL # 4655 PO BOX 95000
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-4500
  • Fax: 212-423-4577
Mailing address:
  • Phone: 800-444-6020
  • Fax: 845-256-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number080517
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: