Provider Demographics
NPI:1386326320
Name:TAINTOR, DECLAN (LMSW)
Entity type:Individual
Prefix:
First Name:DECLAN
Middle Name:
Last Name:TAINTOR
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 1:836 BERGEN ST APT 417
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-7459
Mailing Address - Country:US
Mailing Address - Phone:908-309-0611
Mailing Address - Fax:
Practice Address - Street 1:836 BERGEN ST APT 417
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-7459
Practice Address - Country:US
Practice Address - Phone:908-309-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120379104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker