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General NPI Number Information
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NPI Number | 1619769023
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Entity Type | Individual
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Provider Name | NATHANIEL TABACHNIK LMSW
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Gender | Male
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 109 N 12TH ST STE 817
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City | BROOKLYN
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State | NY
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Zip | 11249-1002
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Country | US
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Telephone | 617-851-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ECKFORD ST APT 2
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City | BROOKLYN
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State | NY
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Zip | 11222-3219
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Country | US
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Telephone | 617-851-0689
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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 | 121806-01
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License Number State | NY
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