Healthcare Provider Details

I. General information

NPI: 1679724132
Provider Name (Legal Business Name): MARIAM KHALIQUE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 W 23RD ST BRIGHTPOINT HEALTH- HEADQUARTERS
NEW YORK NY
10010-4102
US

IV. Provider business mailing address

71 W 23RD ST BRIGHTPOINT HEALTH- HEADQUARTERS
NEW YORK NY
10010-4102
US

V. Phone/Fax

Practice location:
  • Phone: 718-681-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-R
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: