Healthcare Provider Details

I. General information

NPI: 1336922327
Provider Name (Legal Business Name): KATIE LEIGH LYVER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 4TH AVE
BAY SHORE NY
11706-7908
US

IV. Provider business mailing address

205 ARNOLD AVE
WEST BABYLON NY
11704-7211
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-6707
  • Fax:
Mailing address:
  • Phone: 631-671-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405158-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: