Healthcare Provider Details

I. General information

NPI: 1790926558
Provider Name (Legal Business Name): BEVERLY O PRYOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARSONS BLVD
FLUSHING NY
11355-2205
US

IV. Provider business mailing address

2410 AVALON PINES DR
CORAM NY
11727-5149
US

V. Phone/Fax

Practice location:
  • Phone: 718-640-5996
  • Fax:
Mailing address:
  • Phone: 631-813-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: