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General NPI Number Information
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NPI Number | 1255164174
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Entity Type | Individual
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Provider Name | MUBARIKA SAKINA MIRZA LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/26/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 46 REYNOLDS RD
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City | FORT EDWARD
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State | NY
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Zip | 12828-9217
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Country | US
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Telephone | 518-573-0239
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Fax |
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Provider Business Mailing Address
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Address Line | 2661 W 2ND ST APT 3J
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City | BROOKLYN
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State | NY
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Zip | 11223-6359
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Country | US
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Telephone |
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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 | 120883-01
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License Number State | NY
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