Provider Demographics
NPI:1003060013
Name:JOAN POELVOORDE LCSW PC
Entity Type:Organization
Organization Name:JOAN POELVOORDE LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POELVOORDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-473-0138
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-0265
Mailing Address - Country:US
Mailing Address - Phone:646-473-0138
Mailing Address - Fax:646-473-0140
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PENTHOUSE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:646-473-0138
Practice Address - Fax:646-473-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0197741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NB3272Medicare PIN