Healthcare Provider Details

I. General information

NPI: 1881223758
Provider Name (Legal Business Name): ANA NICOLE SCALI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA NICOLE FAKIRIS LCSW

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 COLUMBUS AVE
THORNWOOD NY
10594-1909
US

IV. Provider business mailing address

4 STALLION DR
CHESTERFIELD NJ
08515-9785
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6262
  • Fax:
Mailing address:
  • Phone: 516-993-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108211
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: