Healthcare Provider Details
I. General information
NPI: 1225431604
Provider Name (Legal Business Name): BEGDAN INTEGRATED COUNSELING LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/30/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
223 OTIS AVE
STATEN ISLAND NY
10306-3111
US
IV. Provider business mailing address
223 OTIS AVE
STATEN ISLAND NY
10306-3111
US
V. Phone/Fax
- Phone: 212-203-6434
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
BAIANA
TURATOVA
Title or Position: SOLE PROPRIETOR
Credential: LCSW, CCM
Phone: 212-203-6434