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General NPI Number Information
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NPI Number | 1235664491
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Entity Type | Organization
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Legal Business Name | CONFIDENTIAL LCSW SERVICES,P.C.
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 3047 BRIGHTON 14TH ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-5501
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Country | US
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Telephone | 917-544-5473
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Fax |
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Provider Business Mailing Address
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Address Line | 3047 BRIGHTON 14TH ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-5501
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Country | US
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Telephone | 917-544-5473
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TATYANA SHAHOVA
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Credential | LCSW
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Telephone | 917-544-5473
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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 | 084662
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License Number State | NY
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