Basic Information
| Provider Information | |||||||||
| NPI: | 1013566157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASIMIR | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | KENDRA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 QUENTIN RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112232341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189983235 | ||||||||
| FaxNumber: | 7183363040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 QUENTIN RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112232341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189983235 | ||||||||
| FaxNumber: | 7183363040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2019 | ||||||||
| LastUpdateDate: | 03/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 05/29/2020 | ||||||||
| NPIReactivationDate: | 02/26/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 105927 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.