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NPI Code Detail

MEDICARE: MR. PHILIP JOHN CLANCEY LCSW

MEDICARE: MR. PHILIP JOHN CLANCEY LCSW
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 WorkerR-025973-1NY

General Provider Information

NPI Number : 1497813760
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILIP JOHN CLANCEY LCSW
Provider Business Mailing Address
First Line : 35-34 77TH ST
Second Line : #21
City : JACKSON HTS
State : NY
Zip : 11372-6143
Country : US
Telephone Number : 718-639-4732
Fax Number :
Provider Business Practice Location Address
First Line : 3764 72ND ST
Second Line : OCNI
City : JACKSON HTS
State : NY
Zip : 11372-6143
Country : US
Telephone Number : 718-335-3434
Fax Number : 718-335-4731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 09/22/2016

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Directions to “ MR. PHILIP JOHN CLANCEY LCSW” Practice Location

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