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NPI Code Detail

MEDICARE: HELEN MACK LCSW

MEDICARE: HELEN MACK 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
11041C0700XClinical Social WorkerR016887NY

General Provider Information

NPI Number : 1568639524
Entity Type Code : Individual
Provider Name (Legal Business Name) : HELEN MACK LCSW
Provider Business Mailing Address
First Line : 790 PARK AVE
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4516
Country : US
Telephone Number : 631-427-3700
Fax Number : 631-427-0287
Provider Business Practice Location Address
First Line : 208 ROANOKE AVE
Second Line :
City : RIVERHEAD
State : NY
Zip : 11901-2706
Country : US
Telephone Number : 631-369-0104
Fax Number : 631-369-5433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 05/09/2008

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Directions to “ HELEN MACK LCSW” Practice Location

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