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General NPI Number Information
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NPI Number | 1497079461
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Entity Type | Individual
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Provider Name | CELINE BOBB-INNISS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 250 FULTON AVE STE 418
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City | HEMPSTEAD
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State | NY
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Zip | 11550-3916
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Country | US
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Telephone | 516-858-5001
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Fax | 646-274-3955
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Provider Business Mailing Address
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Address Line | 11305 202ND ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2530
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Country | US
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Telephone | 718-264-7803
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R047220-1
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License Number State | NY
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