Provider Demographics
NPI:1104328988
Name:NANCY A IVRY LCSW PC
Entity type:Organization
Organization Name:NANCY A IVRY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-458-3909
Mailing Address - Street 1:90 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6404
Mailing Address - Country:US
Mailing Address - Phone:516-458-3027
Mailing Address - Fax:516-308-1190
Practice Address - Street 1:136 WOODBURY RD STE 101C
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1411
Practice Address - Country:US
Practice Address - Phone:516-458-3909
Practice Address - Fax:516-308-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086522-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487066882OtherNPI