Provider Demographics
NPI:1902959208
Name:NAGEL, LAURI RISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:RISA
Last Name:NAGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 14TH ST
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5110
Mailing Address - Country:US
Mailing Address - Phone:718-768-8138
Mailing Address - Fax:
Practice Address - Street 1:360 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5110
Practice Address - Country:US
Practice Address - Phone:718-832-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054142-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0541421OtherHIP
NY02006522Medicaid
NYP2679477OtherOXFORD
NY02006522Medicaid