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General NPI Number Information
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NPI Number | 1669512679
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Entity Type | Individual
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Provider Name | FANNY T. IGLESIAS LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 47 HUMPHREY DR
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City | SYOSSET
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State | NY
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Zip | 11791-4022
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Country | US
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Telephone | 516-921-7171
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Fax | 516-496-4958
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Provider Business Mailing Address
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Address Line | 10 W 22ND ST
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City | DEER PARK
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State | NY
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Zip | 11729-3922
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Country | US
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Telephone | 516-921-7171
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Fax | 516-496-4958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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