Healthcare Provider Details

I. General information

NPI: 1972647006
Provider Name (Legal Business Name): ADA FRUMERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OCMH 1430 SECOND AVENUE SUITE 201
NEW YORK NY
10021
US

IV. Provider business mailing address

354 BALTIC ST
BROOKLYN NY
11201-6485
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-6143
  • Fax: 212-717-5691
Mailing address:
  • Phone: 718-625-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR015261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: