Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | NY | |
N | 101YM0800X | Mental Health Counselor | NY |
NPI | 1003345950 |
---|---|
Provider Name | Marawan Elwakil |
First Address | Brooklyn, NY 11229-1209 |
Second Address | Brooklyn, NY 11229-1209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2017 |
Last Update Date | 05/06/2017 |