Provider Demographics
NPI:1912352964
Name:POPP, MICHAEL WAYNE (LCSW/R)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:POPP
Suffix:
Gender:M
Credentials:LCSW/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3505 HILL BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:YORKTOWN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1283
Mailing Address - Country:US
Mailing Address - Phone:914-245-6300
Mailing Address - Fax:914-245-3673
Practice Address - Street 1:3505 HILL BLVD
Practice Address - Street 2:STE. A
Practice Address - City:YORKTOWN HTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1283
Practice Address - Country:US
Practice Address - Phone:914-245-6300
Practice Address - Fax:914-245-3673
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069876-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical