Healthcare Provider Details

I. General information

NPI: 1609232446
Provider Name (Legal Business Name): JOHN PRICE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2016
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 W MAIN ST UNIT 10
SAYVILLE NY
11782-2528
US

IV. Provider business mailing address

186 W MAIN ST UNIT 10
SAYVILLE NY
11782-2528
US

V. Phone/Fax

Practice location:
  • Phone: 434-470-1625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083740-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: