| Jean Bacon | |
|
83 E Main St Bay Shore NY 11706-8305 | |
| (631) 666-5067 | |
| (631) 593-5472 |
| Full Name | Jean Bacon |
|---|---|
| Speciality | Social Worker |
| Location | 83 E Main St, Bay Shore, New York |
| Authorized Official Name and Position | Jean Bacon (CLINICAL DIRECTOR) |
| Authorized Official Contact | 6316665067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jean Bacon 34 Fire Road Dr Bay Shore NY 11706-3947 Ph: (631) 666-1951 | Jean Bacon 83 E Main St Bay Shore NY 11706-8305 Ph: (631) 666-5067 |
| NPI Number | 1023349297 |
|---|---|
| Provider Enumeration Date | 01/27/2010 |
| Last Update Date | 04/14/2020 |
| Certification Date | 04/14/2020 |
| Medicare PECOS PAC ID | 7719013218 |
|---|---|
| Medicare Enrollment ID | O20100408000277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023349297 | NPI | - | NPPES |
| A100024503 | Other | NY | MEDICARE GROUP PTAN |
| Provider Name | Jean L Bacon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184846818 PECOS PAC ID: 4486703808 Enrollment ID: I20090514000135 |
| Provider Name | Suzanne L Velazquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992021604 PECOS PAC ID: 7315324191 Enrollment ID: I20220517001171 |
| Provider Name | Brian R Coyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669953758 PECOS PAC ID: 9537546221 Enrollment ID: I20220518002691 |
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