1477751006 NPI number — MRS. RUAN DAVINA SOMERVILLE LCSW

Table of content: MRS. RUAN DAVINA SOMERVILLE LCSW (NPI 1477751006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477751006 NPI number — MRS. RUAN DAVINA SOMERVILLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMERVILLE
Provider First Name:
RUAN
Provider Middle Name:
DAVINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMNARINE
Provider Other First Name:
RUAN
Provider Other Middle Name:
DAVINA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477751006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 TENEYCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY STREAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11580-4016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-284-7994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 BEACH CHANNEL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARVERNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-945-7150
Provider Business Practice Location Address Fax Number:
718-634-4838
Provider Enumeration Date:
07/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  071513 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00990152 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".