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NPI Code Detail

MEDICARE: MR. ALAN VINCENT IVICIC LCSW-R

MEDICARE: MR. ALAN VINCENT IVICIC LCSW-R
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker079338NY

General Provider Information

NPI Number : 1013163187
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALAN VINCENT IVICIC LCSW-R
Provider Business Mailing Address
First Line : 220 ROUTE 6
Second Line :
City : MAHOPAC
State : NY
Zip : 10541-3850
Country : US
Telephone Number : 917-336-4289
Fax Number :
Provider Business Practice Location Address
First Line : 220 ROUTE 6
Second Line :
City : MAHOPAC
State : NY
Zip : 10541-3850
Country : US
Telephone Number : 917-336-4289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2008
Last Update Date : 05/07/2026

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