Healthcare Provider Details

I. General information

NPI: 1558845032
Provider Name (Legal Business Name): IAN SEXTON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CADMAN PLZ W FL 17
BROOKLYN NY
11201-3229
US

IV. Provider business mailing address

3264 41ST ST APT 4D
ASTORIA NY
11103-3562
US

V. Phone/Fax

Practice location:
  • Phone: 844-434-2778
  • Fax:
Mailing address:
  • Phone: 513-373-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104026
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: