MEDICARE: MR. NEIL HENRY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	014272	NY

General Provider Information

NPI Number	:	1386705523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEIL HENRY LCSW

Provider Business Mailing Address
First Line	:	775 BROOKLYN AVE STE 112
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2948
Country	:	US
Telephone Number	:	516-868-0444
Fax Number	:	360-272-0444

Provider Business Practice Location Address
First Line	:	775 BROOKLYN AVE
Second Line	:	SUITE 112
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2948
Country	:	US
Telephone Number	:	516-868-0444
Fax Number	:	516-868-0444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	04/23/2026

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