Provider Demographics
NPI:1194329953
Name:PETIT-FRERE, WALKENS (LMSW)
Entity type:Individual
Prefix:MR
First Name:WALKENS
Middle Name:
Last Name:PETIT-FRERE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 ADAM CLAYTON POWELL JR BLVD APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1770
Mailing Address - Country:US
Mailing Address - Phone:917-499-9876
Mailing Address - Fax:
Practice Address - Street 1:348 13TH ST STE 203
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6179
Practice Address - Country:US
Practice Address - Phone:917-499-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112377102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst