Provider Demographics
NPI:1407680648
Name:EB LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
Entity type:Organization
Organization Name:EB LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SING KIT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-304-9203
Mailing Address - Street 1:301 REDMONT RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3025
Mailing Address - Country:US
Mailing Address - Phone:516-587-4312
Mailing Address - Fax:
Practice Address - Street 1:65 FROEHLICH FARM BLVD # 812W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2926
Practice Address - Country:US
Practice Address - Phone:516-587-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)