1134219496 NPI number — MS. LUCY L. O'FLAHERTY LCSW

Table of content: MS. LUCY L. O'FLAHERTY LCSW (NPI 1134219496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134219496 NPI number — MS. LUCY L. O'FLAHERTY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'FLAHERTY
Provider First Name:
LUCY
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
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:
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:
1134219496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 PINE AVE
Provider Second Line Business Mailing Address:
F.E.G.S. 445 OAK STREET COPIAGUE, NY LL726
Provider Business Mailing Address City Name:
BETHPAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11714-1212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-827-0705
Provider Business Mailing Address Fax Number:
516-827-0705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 PINE AVE
Provider Second Line Business Practice Location Address:
F.E.G.S. 445 OAK STREET COPIAGUE, NY LL726
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-827-0705
Provider Business Practice Location Address Fax Number:
516-827-0705
Provider Enumeration Date:
10/14/2006

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: 1041C0700X , with the licence number:  PO45690 , 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: 01948416 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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