Provider Demographics
NPI:1588100242
Name:LOUIS-DREYFUS, PHOEBE (MSW)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:LOUIS-DREYFUS
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 1:67 RIVERSIDE DR
Mailing Address - Street 2:APT. 7B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6135
Mailing Address - Country:US
Mailing Address - Phone:917-930-9007
Mailing Address - Fax:
Practice Address - Street 1:67 RIVERSIDE DR
Practice Address - Street 2:APT. 7B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6135
Practice Address - Country:US
Practice Address - Phone:917-930-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052522-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health