Provider Demographics
NPI:1972669885
Name:CHERNACK, PHYLLIS BLEY (LCSW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:BLEY
Last Name:CHERNACK
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 1:15 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4900
Mailing Address - Country:US
Mailing Address - Phone:516-483-1661
Mailing Address - Fax:212-582-5476
Practice Address - Street 1:399 JUNE PL
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2812
Practice Address - Country:US
Practice Address - Phone:516-483-1661
Practice Address - Fax:212-582-5476
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020487 5778970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7771158OtherAETNA
NYN3M581Medicare ID - Type Unspecified
NY108580Medicare UPIN