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General NPI Number Information
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NPI Number | 1316695018
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Entity Type | Organization
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Legal Business Name | EVAN MICHAELS LCSW PC
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Dates
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Enumeration Date | 03/13/2022
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Last Update Date | 03/13/2022
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Provider Practice Location Address
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Address Line | 2116 MERRICK AVE STE 2001
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City | MERRICK
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State | NY
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Zip | 11566-3409
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Country | US
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Telephone | 917-576-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 MERRICK AVE STE 2001
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City | MERRICK
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State | NY
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Zip | 11566-3409
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Country | US
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Telephone | 917-576-0720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EVAN M MICHAELS
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Credential | LCSW
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Telephone | 917-576-0720
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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 |
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License Number State |
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