Basic Information
| Provider Information | |||||||||
| NPI: | 1548375090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUAREZ-KARIC | ||||||||
| FirstName: | ABIGAIL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 W 15TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129246324 | ||||||||
| FaxNumber: | 2126915635 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 HAVEMEYER ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112116277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189634430 | ||||||||
| FaxNumber: | 7189630814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 034914 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 040426033418 | 01 | NY | FIDELIS PROVIDER NUMBER | OTHER |