Provider Demographics
NPI:1154938512
Name:FURTICK, VICTOR (LCSW)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:FURTICK
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 1:397 BRIDGE ST FL 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5247
Mailing Address - Country:US
Mailing Address - Phone:631-213-7940
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGE ST FL 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5247
Practice Address - Country:US
Practice Address - Phone:631-213-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
TX1047781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical