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NPI Code Detail

MEDICARE: MS. IRENE SOFIA KOUTSIDIS-MARTELLI LCSW

MEDICARE: MS. IRENE SOFIA KOUTSIDIS-MARTELLI 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
1104100000XSocial Worker109203NY
21041C0700XClinical Social Worker097650NY
31041C0700XClinical Social Worker18552SC

General Provider Information

NPI Number : 1518584341
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IRENE SOFIA KOUTSIDIS-MARTELLI LCSW
Provider Business Mailing Address
First Line : 16610 POWELLS COVE BLVD APT 8A
Second Line :
City : WHITESTONE
State : NY
Zip : 11357-1504
Country : US
Telephone Number : 347-256-4597
Fax Number :
Provider Business Practice Location Address
First Line : 79 MIDDLEVILLE RD
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-2296
Country : US
Telephone Number : 631-261-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2020
Last Update Date : 06/10/2026

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