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NPI Code Detail

MEDICARE: MR. IAN R NEVILLE MHC-LP

MEDICARE: MR. IAN R NEVILLE MHC-LP
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
1101YM0800XMental Health CounselorP114348NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P114348OTHERNYNEW YORK DEPARTMENT OF EDUCATION

General Provider Information

NPI Number : 1205572088
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IAN R NEVILLE MHC-LP
Provider Business Mailing Address
First Line : 15 CLENT RD APT 1D
Second Line :
City : GREAT NECK PLAZA
State : NY
Zip : 11021-3493
Country : US
Telephone Number : 585-469-3397
Fax Number :
Provider Business Practice Location Address
First Line : 535 S OYSTER BAY RD
Second Line :
City : PLAINVIEW
State : NY
Zip : 11803-3310
Country : US
Telephone Number : 516-818-8383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2022
Last Update Date : 06/07/2022

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