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General NPI Number Information
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NPI Number | 1306049085
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Entity Type | Individual
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Provider Name | LUIBOV BERHANU LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 19 W 34TH ST PENTHOUSE
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 212-947-7111
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Fax | 212-239-0948
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Provider Business Mailing Address
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Address Line | 19 W 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 212-868-4899
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Fax | 212-868-4899
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12859
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 075596
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License Number State | NY
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