| Diane Gavares Licensed Clinical Social Worker P.c. | |
|
3 Middle Cross Shoreham NY 11786-1441 | |
| (631) 849-2341 | |
| Not Available |
| Full Name | Diane Gavares Licensed Clinical Social Worker P.c. |
|---|---|
| Speciality | Social Worker |
| Location | 3 Middle Cross, Shoreham, New York |
| Authorized Official Name and Position | Diane Gavares (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6318492341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diane Gavares Licensed Clinical Social Worker P.c. 3 Middle Cross Shoreham NY 11786-1441 Ph: (631) 849-2341 | Diane Gavares Licensed Clinical Social Worker P.c. 3 Middle Cross Shoreham NY 11786-1441 Ph: (631) 849-2341 |
| NPI Number | 1417582909 |
|---|---|
| Provider Enumeration Date | 03/05/2020 |
| Last Update Date | 03/05/2020 |
| Certification Date | 03/05/2020 |
| Medicare PECOS PAC ID | 9931510336 |
|---|---|
| Medicare Enrollment ID | O20201116000783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417582909 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Diane Gavares |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780995316 PECOS PAC ID: 1355625328 Enrollment ID: I20170313000764 |
Shoreham Psychotherapy Services Lcsw Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 45 Route 25a, Suite A2, Shoreham, NY 11786 Phone: 631-821-5056 Fax: 631-821-5056 |