Provider Demographics
NPI:1285307827
Name:NAGEL, ILSA MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:ILSA
Middle Name:MARIE
Last Name:NAGEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104-70 QUEENS BLVD.
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-275-6010
Mailing Address - Fax:
Practice Address - Street 1:104-70 QUEENS BLVD.
Practice Address - Street 2:FLOOR 2
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111080104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker