Provider Demographics
NPI:1487979498
Name:FEDERN, THOMAS RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:FEDERN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK AVE
Mailing Address - Street 2:RPC YONKERS SERVICE CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3402
Mailing Address - Country:US
Mailing Address - Phone:914-969-0543
Mailing Address - Fax:914-969-3643
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:RPC YONKERS SERVICE CENTER
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3402
Practice Address - Country:US
Practice Address - Phone:914-969-0543
Practice Address - Fax:914-969-3643
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730207831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY73020783OtherNEW YORK STATE DEPARTMENT OF EDUCATION