| New York Licensed Clinical Social Work, Pc | |
|
5 Bertram St Islip NY 11751-1001 | |
| (866) 949-0108 | |
| Not Available |
| Full Name | New York Licensed Clinical Social Work, Pc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5 Bertram St, Islip, New York |
| Authorized Official Name and Position | Kimberly Mann (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9014227608 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New York Licensed Clinical Social Work, Pc 50 S B B King Blvd Memphis TN 38103-2626 Ph: (901) 422-7644 | New York Licensed Clinical Social Work, Pc 5 Bertram St Islip NY 11751-1001 Ph: (866) 949-0108 |
| NPI Number | 1669138699 |
|---|---|
| Provider Enumeration Date | 11/15/2021 |
| Last Update Date | 12/27/2021 |
| Certification Date | 12/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669138699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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