Healthcare Provider Details

I. General information

NPI: 1467453043
Provider Name (Legal Business Name): DAVID FLOMENHAFT PHD, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

96 SYDNEY AVE
MALVERNE NY
11565-1135
US

IV. Provider business mailing address

96 SYDNEY AVE
MALVERNE NY
11565-1135
US

V. Phone/Fax

Practice location:
  • Phone: 516-596-0739
  • Fax: 516-596-0739
Mailing address:
  • Phone: 516-596-0739
  • Fax: 516-596-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR031673-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: