Provider Demographics
NPI:1699916718
Name:KENNY BAZADONA, ERIN (LMSW)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:KENNY BAZADONA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PARK AVE
Mailing Address - Street 2:APT. 3L
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-8100
Mailing Address - Country:US
Mailing Address - Phone:201-683-4084
Mailing Address - Fax:
Practice Address - Street 1:116 JOHN ST
Practice Address - Street 2:CIS COUNSELING 27TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3300
Practice Address - Country:US
Practice Address - Phone:212-385-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078394-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical