Provider Demographics
NPI:1699160002
Name:BISSU, ADELE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ADELE
Middle Name:
Last Name:BISSU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:JOY
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4730 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3343
Mailing Address - Country:US
Mailing Address - Phone:917-957-4369
Mailing Address - Fax:
Practice Address - Street 1:4730 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3343
Practice Address - Country:US
Practice Address - Phone:917-957-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097529104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker