Provider Demographics
NPI:1063992212
Name:ABREU, JOHN CARLOS (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARLOS
Last Name:ABREU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FISHER AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1919
Mailing Address - Country:US
Mailing Address - Phone:845-600-4244
Mailing Address - Fax:
Practice Address - Street 1:1420 FERRIS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3611
Practice Address - Country:US
Practice Address - Phone:718-239-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0917361041C0700X
NY103383-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical