Healthcare Provider Details

I. General information

NPI: 1043613425
Provider Name (Legal Business Name): KISHAUNA SINCLAIR LMSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD
REGO PARK NY
11374-4357
US

IV. Provider business mailing address

101-125 W 147TH ST APT 17I
NEW YORK NY
10039-4343
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax:
Mailing address:
  • Phone: 914-458-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: