MEDICARE: WOVEN THREADS PSYCHOTHERAPY LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356162960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOVEN THREADS PSYCHOTHERAPY LCSW PLLC

Provider Business Mailing Address
First Line	:	1626 E 51ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3822
Country	:	US
Telephone Number	:	646-470-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CADMAN PLAZA WEST
Second Line	:	12TH FLOOR - #5025
City	:	BROOKLYN
State	:	NY
Zip	:	11201
Country	:	US
Telephone Number	:	646-470-8787
Fax Number	:

Authorized Official
Title or Position	:	MEMBER-MANAGER
Name	:	DR. HEBAH KHALIFA
Credential	:	PH.D., MSW
Telephone Number	:	646-470-8787

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	02/11/2025

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