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General NPI Number Information
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NPI Number | 1174461891
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Entity Type | Individual
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Provider Name | HAMIDREZA HARRISON FADAVI
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Gender | Male
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 631 FOSTER AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-1304
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Country | US
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Telephone | 718-859-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 350 LINCOLN PL APT 2N
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City | BROOKLYN
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State | NY
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Zip | 11238-5842
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Country | US
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Telephone | 929-664-7247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 128864
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License Number State | NY
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