Healthcare Provider Details

I. General information

NPI: 1285543090
Provider Name (Legal Business Name): IVY YOUNG-BELL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 JOHNSON AVE STE 9
BOHEMIA NY
11716-2687
US

IV. Provider business mailing address

606 JOHNSON AVE STE 9
BOHEMIA NY
11716-2687
US

V. Phone/Fax

Practice location:
  • Phone: 646-481-2762
  • Fax: 631-203-9599
Mailing address:
  • Phone: 646-481-2762
  • Fax: 631-203-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: