1689767592 NPI number — MRS. MERYL SUSAN LEFF LCSW, CASAC, BCD

Table of content: MRS. MERYL SUSAN LEFF LCSW, CASAC, BCD (NPI 1689767592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689767592 NPI number — MRS. MERYL SUSAN LEFF LCSW, CASAC, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEFF
Provider First Name:
MERYL
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CASAC, BCD
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:
1689767592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 338
Provider Business Mailing Address City Name:
BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11702-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-893-6355
Provider Business Mailing Address Fax Number:
631-893-6355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 338
Provider Business Practice Location Address City Name:
BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11702-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-893-6355
Provider Business Practice Location Address Fax Number:
631-893-6355
Provider Enumeration Date:
10/02/2006

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: 101YA0400X , with the licence number:  10712 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: R049140-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2649282 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UN. BEH. HEALTH PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 131751 . This is a "VYTRA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161543 MHS . This is a "VALUE OPTIONS PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7480430 . This is a "GHI PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NX4021 . This is a "BLUE CROSS PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02116558 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1435082 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2559539 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 303899 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42259P . This is a "HIP PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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