Basic Information
| Provider Information | |||||||||
| NPI: | 1376197319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENNETH MYERS, LCSW, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8638 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101168638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6468469651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 7TH AVE RM 2501 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100018400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6468469651 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6468469651 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.