Provider Demographics
NPI:1366791188
Name:SOSOWSKY, JAY (MSW)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:SOSOWSKY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 EAST 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2915
Mailing Address - Country:US
Mailing Address - Phone:718-645-1317
Mailing Address - Fax:
Practice Address - Street 1:1860 EAST 18TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2915
Practice Address - Country:US
Practice Address - Phone:718-645-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042367-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool