Healthcare Provider Details

I. General information

NPI: 1053046292
Provider Name (Legal Business Name): SIMONE ELISE MUSCHETT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 PUTNEY RD
VALLEY STREAM NY
11580-1818
US

IV. Provider business mailing address

1361 E 83RD ST
BROOKLYN NY
11236-5101
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-5075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: