=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851600894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN M CONTI LCSW-R, DSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2010
-----------------------------------------------------
Last Update Date | 10/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 PEARSALL AVE
-----------------------------------------------------
City | FREEPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11520-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-574-1018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 PEARSALL AVE
-----------------------------------------------------
City | FREEPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11520-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-574-1018
-----------------------------------------------------
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 | 73 082534
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------