=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306311642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING WELL LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2018
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 188 WOODPOINT RD APT 1A
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11211-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-701-2220
-----------------------------------------------------
Fax | 718-701-2225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 WOODPOINT RD APT 1A
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11211-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-701-2220
-----------------------------------------------------
Fax | 718-701-2225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL BERNATOWICZ
-----------------------------------------------------
Credential | LCSW-R
-----------------------------------------------------
Telephone | 718-701-2220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------