Healthcare Provider Details

I. General information

NPI: 1023177763
Provider Name (Legal Business Name): CELESTE KROCHAK GARSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CELESTE KROCHAK LCSW

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 89TH ST APT 7H
NEW YORK NY
10128-6734
US

IV. Provider business mailing address

400 E 89TH ST APT 7H
NEW YORK NY
10128-6734
US

V. Phone/Fax

Practice location:
  • Phone: 917-225-8223
  • Fax:
Mailing address:
  • Phone: 917-225-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR049232
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberR049232-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: