Healthcare Provider Details

I. General information

NPI: 1386705523
Provider Name (Legal Business Name): NEIL HENRY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 BROOKLYN AVE SUITE 112
NORTH BALDWIN NY
11510-2948
US

IV. Provider business mailing address

775 BROOKLYN AVE STE 112
NORTH BALDWIN NY
11510-2948
US

V. Phone/Fax

Practice location:
  • Phone: 516-868-0444
  • Fax: 516-868-0444
Mailing address:
  • Phone: 516-868-0444
  • Fax: 360-272-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number014272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: