Healthcare Provider Details

I. General information

NPI: 1285720706
Provider Name (Legal Business Name): NANCY WARREN VAN DYKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MAIN AVENUE
SEA CLIFF NY
11579-1330
US

IV. Provider business mailing address

65 MAIN AVENUE
SEA CLIFF NY
11579-1330
US

V. Phone/Fax

Practice location:
  • Phone: 516-759-1216
  • Fax: 516-674-2115
Mailing address:
  • Phone: 516-759-1216
  • Fax: 516-674-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR007761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: