Healthcare Provider Details

I. General information

NPI: 1700137023
Provider Name (Legal Business Name): HENRY MAGAISA JANGIRA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169-59 137TH AVE
ROCHDALE NY
11434
US

IV. Provider business mailing address

55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-525-5600
  • Fax: 718-559-5285
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085373
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number085373
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number085373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: