=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760844542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAN FIORE LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2016
-----------------------------------------------------
Last Update Date | 03/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 232 W 16TH ST APT R
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-924-2291
-----------------------------------------------------
Fax | 252-377-4231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 PARK AVE S 5TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-6902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-924-2291
-----------------------------------------------------
Fax | 252-377-4231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAN FIORE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 917-924-2291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------