Provider Demographics
NPI:1285289793
Name:FELSENBURG, PESSY
Entity type:Individual
Prefix:
First Name:PESSY
Middle Name:
Last Name:FELSENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 4TH AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7066
Mailing Address - Country:US
Mailing Address - Phone:718-238-6444
Mailing Address - Fax:718-238-5165
Practice Address - Street 1:9201 4TH AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7066
Practice Address - Country:US
Practice Address - Phone:718-238-6444
Practice Address - Fax:718-238-5165
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106936104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106936OtherNEW YORK STATE EDUCATION DEPARTMENT - OFFICE OF THE PROFESSIONS