1710492335 NPI number — TZILA CHANA SEEWALD-RUSSELL LMSW

Table of content: TZILA CHANA SEEWALD-RUSSELL LMSW (NPI 1710492335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710492335 NPI number — TZILA CHANA SEEWALD-RUSSELL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEWALD-RUSSELL
Provider First Name:
TZILA
Provider Middle Name:
CHANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEEWALD
Provider Other First Name:
TZILA
Provider Other Middle Name:
CHANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710492335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1578 E 29TH ST # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11229-1898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-686-3400
Provider Business Mailing Address Fax Number:
718-686-4554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6023 FORT HAMILTON PKWY # 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-4814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-686-3400
Provider Business Practice Location Address Fax Number:
718-686-4554
Provider Enumeration Date:
12/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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