Provider Demographics
NPI:1992957450
Name:HALPERN, MISHELE I (LCSW)
Entity type:Individual
Prefix:
First Name:MISHELE
Middle Name:I
Last Name:HALPERN
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 1:5 BRAMBLE LN
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2330
Mailing Address - Country:US
Mailing Address - Phone:631-367-7203
Mailing Address - Fax:
Practice Address - Street 1:145 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3438
Practice Address - Country:US
Practice Address - Phone:631-367-7203
Practice Address - Fax:631-367-7203
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0633251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN74651Medicare PIN
NYP84694Medicare UPIN