MEDICARE: PRIME LCSW SERVICES PC

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	104100000X	Social Worker	R070268-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700302577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME LCSW SERVICES PC

Provider Business Mailing Address
First Line	:	7207 FALSTON CIR
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857-7002
Country	:	US
Telephone Number	:	646-203-2882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	718-645-4800
Fax Number	:	718-331-3387

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOFIA DOUBININE
Credential	:	LCSW-R
Telephone Number	:	646-203-2882

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	09/16/2025

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