Provider Demographics
NPI:1851462741
Name:PROFUMO, ADOLFO E (LCSW)
Entity type:Individual
Prefix:MR
First Name:ADOLFO
Middle Name:E
Last Name:PROFUMO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CENTRAL PARK WEST
Mailing Address - Street 2:SUITE 1AD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-678-2015
Mailing Address - Fax:212-280-2424
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:SUITE 1AD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-678-2015
Practice Address - Fax:212-280-2424
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0394831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N2J521Medicare ID - Type Unspecified