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General NPI Number Information
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NPI Number | 1578899415
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Entity Type | Organization
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Legal Business Name | NEW YORK CREATIVE ARTS THERAPISTS PLLC
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 190 N 10TH ST SUITE 301
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City | BROOKLYN
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State | NY
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Zip | 11211-9317
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Country | US
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Telephone | 917-293-4642
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Fax |
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Provider Business Mailing Address
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Address Line | 190 N 10TH ST SUITE 301
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City | BROOKLYN
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State | NY
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Zip | 11211-9317
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Country | US
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Telephone | 917-293-4642
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DRENA FAGEN
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Credential | LCAT, LCSW-R
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Telephone | 917-293-4642
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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 | 077035
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 0000144
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 000250
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License Number State | NY
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