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General NPI Number Information
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NPI Number | 1124567029
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Entity Type | Organization
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Legal Business Name | BC53, LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 3 BELMONT AVE
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City | BROOKLYN
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State | NY
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Zip | 11212-6443
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Country | US
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Telephone | 347-256-4991
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Fax |
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Provider Business Mailing Address
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Address Line | 95 JOAN AVE
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City | CENTEREACH
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State | NY
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Zip | 11720-4431
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Country | US
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Telephone | 347-256-4991
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | LENNIE CARTER
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Credential |
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Telephone | 347-256-4991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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