Basic Information
| Provider Information | |||||||||
| NPI: | 1669809364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONDE | ||||||||
| FirstName: | HENRY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1051 ESTHER ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN SQUARE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110101406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162331636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115503917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164855710 | ||||||||
| FaxNumber: | 5162609051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2013 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 08979 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 085810 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.