=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134643091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIGNY FURIYA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2017
-----------------------------------------------------
Last Update Date | 12/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 OLD ROUTE 82
-----------------------------------------------------
City | MILLBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12545-6139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-509-8049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1240 ROUTE 308 # 1
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-509-8049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 070885-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------