| Prime Lcsw Services Pc | |
|
2345 65th St Brooklyn NY 11204-4045 | |
| (718) 645-4800 | |
| (718) 331-3387 |
| Full Name | Prime Lcsw Services Pc |
|---|---|
| Speciality | Social Worker |
| Location | 2345 65th St, Brooklyn, New York |
| Authorized Official Name and Position | Sofia Doubinine (PRESIDENT) |
| Authorized Official Contact | 6462032882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Lcsw Services Pc 1437 W 4th St Apt 3a Brooklyn NY 11204-4082 Ph: (646) 203-2882 | Prime Lcsw Services Pc 2345 65th St Brooklyn NY 11204-4045 Ph: (718) 645-4800 |
| NPI Number | 1700302577 |
|---|---|
| Provider Enumeration Date | 08/14/2017 |
| Last Update Date | 08/14/2017 |
| Medicare PECOS PAC ID | 0244504058 |
|---|---|
| Medicare Enrollment ID | O20170918002094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700302577 | NPI | - | NPPES |
| 98PU902 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | R070268-1 (New York) | Primary |
| Provider Name | Sofia Doubinine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720174840 PECOS PAC ID: 3870766967 Enrollment ID: I20111107000131 |
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