=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700837580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOKLYN WOMENS & FAMILY COUNSELING SERVICES LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 06/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7706 13TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11228-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-232-8600
-----------------------------------------------------
Fax | 718-228-9314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7706 13TH AVE STE 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11228-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-232-8600
-----------------------------------------------------
Fax | 718-228-9614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NICOLETTA PALLOTTA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 718-232-8600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------