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General NPI Number Information
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NPI Number | 1104328988
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Entity Type | Organization
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Legal Business Name | NANCY A IVRY LCSW PC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 136 WOODBURY RD STE 101C
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City | WOODBURY
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State | NY
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Zip | 11797-1411
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Country | US
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Telephone | 516-458-3909
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Fax | 516-308-1190
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Provider Business Mailing Address
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Address Line | 90 BRIARWOOD LN
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City | PLAINVIEW
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State | NY
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Zip | 11803-6404
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Country | US
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Telephone | 516-458-3027
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Fax | 516-308-1190
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY A IVRY
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Credential | LCSW
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Telephone | 516-458-3909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086522-1
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License Number State | NY
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