Healthcare Provider Details

I. General information

NPI: 1952395089
Provider Name (Legal Business Name): MIRCA MICHAEL UREKE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 FREER ST
LYNBROOK NY
11563-2816
US

IV. Provider business mailing address

298 MADISON AVE
CEDARHURST NY
11516-1434
US

V. Phone/Fax

Practice location:
  • Phone: 516-209-1303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR053804-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: