Provider Demographics
NPI:1386615847
Name:MEAD, ROBIN BRADY (LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:BRADY
Last Name:MEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ELIZABETH
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3 WASHINGTON SQ VLG
Mailing Address - Street 2:APT 11M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1806
Mailing Address - Country:US
Mailing Address - Phone:917-817-8021
Mailing Address - Fax:
Practice Address - Street 1:270 LAFAYETTE ST
Practice Address - Street 2:SUITE 804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2347
Practice Address - Country:US
Practice Address - Phone:917-817-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055961-21041C0700X
NYR0559611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN637H1Medicare ID - Type UnspecifiedMEDICARE PROVIDER