Healthcare Provider Details

I. General information

NPI: 1457753568
Provider Name (Legal Business Name): ANTHONY STUART PICK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367-69 SECOND AVENUE
NEW YORK NY
10035
US

IV. Provider business mailing address

2367-69 SECOND AVENUE HARLEM EAST LIFE PLAN,
NEW YORK NY
10035
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 917-492-9202
Mailing address:
  • Phone: 212-876-2300
  • Fax: 917-492-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: