Provider Demographics
NPI:1083448872
Name:EMBIRICOS, GEORGE PETER (LCSW, CPTT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PETER
Last Name:EMBIRICOS
Suffix:
Gender:M
Credentials:LCSW, CPTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BETHUNE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-1724
Mailing Address - Country:US
Mailing Address - Phone:917-667-1543
Mailing Address - Fax:
Practice Address - Street 1:29 BETHUNE ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1724
Practice Address - Country:US
Practice Address - Phone:917-667-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0983311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical