Provider Information for 1043857675
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HENRIETA DEKA LCSW
Sex: Female
NPI: 1043857675
Last Updated: 2024-10-29
Certification Date: 2024-10-29
Certification Date: 2024-10-29
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1043857675 | ||||||||||||||||
| Enumeration Date | 2019-12-02 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 221 PAMLICO AVE UNIONDALE, NY 11553-1707 United States Phone: 516-660-4721 | Fax: | ||||||||||||||||
| Primary Practice Address | 118-35 QUEENS BOULEVARD FOREST HILLS, NY 11375 United States Phone: 929-346-7176 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 50 W HAWTHORNE AVE | ||||||||||||||||
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