Basic Information
| Provider Information | |||||||||
| NPI: | 1174260939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | NOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5814 84TH ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | MIDDLE VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113795484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178707094 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2581 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112072412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184950920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2022 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.