Healthcare Provider Details

I. General information

NPI: 1508392119
Provider Name (Legal Business Name): MICHELLE TAUB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD STE 106
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

70 HOFSTRA DR
PLAINVIEW NY
11803-1841
US

V. Phone/Fax

Practice location:
  • Phone: 516-319-0143
  • Fax:
Mailing address:
  • Phone: 516-319-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091602-01
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: