Healthcare Provider Details

I. General information

NPI: 1518677160
Provider Name (Legal Business Name): NANCY J SEVILLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 KENWOOD AVE
SLINGERLANDS NY
12159-9621
US

IV. Provider business mailing address

100 FERNBANK AVE
DELMAR NY
12054-4218
US

V. Phone/Fax

Practice location:
  • Phone: 518-265-2698
  • Fax:
Mailing address:
  • Phone: 518-265-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: