Provider Demographics
NPI:1831744945
Name:DOUGLAS, DARIUS (CASAC 2 21849)
Entity type:Individual
Prefix:
First Name:DARIUS
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:CASAC 2 21849
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLEULER PSYCHOTHERAPY CENTER 104-70 QUEENS BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-275-6010
Mailing Address - Fax:
Practice Address - Street 1:BLEULER PSYCHOTHERAPY CENTER 104-70 QUEENS BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21849101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)