Healthcare Provider Details

I. General information

NPI: 1376197319
Provider Name (Legal Business Name): KENNETH MYERS, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 7TH AVE RM 2501
NEW YORK NY
10001-8400
US

IV. Provider business mailing address

PO BOX 8638
NEW YORK NY
10116-8638
US

V. Phone/Fax

Practice location:
  • Phone: 646-846-9651
  • Fax:
Mailing address:
  • Phone: 646-846-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH E MYERS
Title or Position: OWNER
Credential: LCSW
Phone: 646-846-9651