Healthcare Provider Details

I. General information

NPI: 1346514627
Provider Name (Legal Business Name): NOEMI BARCZAK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ROUTE 112 SUITE C
PATCHOGUE NY
11772-1232
US

IV. Provider business mailing address

20 4TH ST
MORICHES NY
11955-1006
US

V. Phone/Fax

Practice location:
  • Phone: 631-873-5879
  • Fax:
Mailing address:
  • Phone: 631-873-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number075504-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: