Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Phoebus Widjaja, LMSW

Individual provider Clinical Social Worker · NPI 1366377996

Mr. Phoebus Widjaja, LMSW is a Clinical Social Worker in Woodside, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2026
What do these letters mean?
LMSW — Licensed Master Social Worker
A master's-level social worker, usually practising under supervision.

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Practice location Address checks out

4021 60th St Apt 2
Woodside, NY 11377-4952
Phone: (917) 595-8969
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 127994 (NY)

Record details

NPI number1366377996
Entity typeIndividual (Type 1)
GenderMale
Credentials LMSW
Sole proprietorYes
NPI enumeratedJune 15, 2026
Last updated in NPPESJune 15, 2026
Certification dateJune 15, 2026

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