1104328988 NPI number — NANCY A IVRY LCSW PC

Table of content: AUTUMN TAYLOR THOMPSON ASW (NPI 1912665878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104328988 NPI number — NANCY A IVRY LCSW PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY A IVRY LCSW PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104328988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 BRIARWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-6404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-458-3027
Provider Business Mailing Address Fax Number:
516-308-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 WOODBURY RD STE 101C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11797-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-458-3909
Provider Business Practice Location Address Fax Number:
516-308-1190
Provider Enumeration Date:
03/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
IVRY
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-458-3909

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  086522-1 , 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: 1487066882 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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