Basic Information
| Provider Information | |||||||||
| NPI: | 1326222001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEFFREY | ||||||||
| FirstName: | IRWIN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 MACDONOUGH ST | ||||||||
| Address2: | 16 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112162330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183983910 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1456 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112162505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186364500 | ||||||||
| FaxNumber: | 3472968310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 09/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 048861 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.