Provider Demographics
NPI:1316169956
Name:CHAMPNEY, ANN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:CHAMPNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CENTRAL ST
Mailing Address - Street 2:APT. B
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1211
Mailing Address - Country:US
Mailing Address - Phone:631-651-5531
Mailing Address - Fax:
Practice Address - Street 1:91 BROADWAY # 101
Practice Address - Street 2:SUITE 6
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1385
Practice Address - Country:US
Practice Address - Phone:516-617-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP060916-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN182Z1Medicare ID - Type Unspecified