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General NPI Number Information
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NPI Number | 1982021143
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Entity Type | Individual
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Provider Name | FANNY PERTNOY LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 515 MADISON AVE FL 21
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City | NEW YORK
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State | NY
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Zip | 10022-5433
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Country | US
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Telephone | 203-984-5686
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Fax |
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Provider Business Mailing Address
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Address Line | 27 W 96TH ST APT 14D
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City | NEW YORK
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State | NY
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Zip | 10025-6525
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Country | US
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Telephone | 203-984-5686
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086153-1
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License Number State | NY
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