Provider Demographics
NPI:1992727457
Name:KAN, DENISE LAI KWAN (LMSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LAI KWAN
Last Name:KAN
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 1:2814 146TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1333
Mailing Address - Country:US
Mailing Address - Phone:718-813-0834
Mailing Address - Fax:
Practice Address - Street 1:268 CANAL STREET
Practice Address - Street 2:CHARLES B. WANG COMMUNITY HEALTH CENTER
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-379-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070885104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker