Provider Demographics
NPI:1003242629
Name:FLETCHER, KEVFOY LENROY (MASTERS IN SOCIAL WK)
Entity Type:Individual
Prefix:MR
First Name:KEVFOY
Middle Name:LENROY
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MASTERS IN SOCIAL WK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1414
Mailing Address - Country:US
Mailing Address - Phone:516-574-3634
Mailing Address - Fax:
Practice Address - Street 1:11 ROUTE 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3739
Practice Address - Country:US
Practice Address - Phone:631-920-8303
Practice Address - Fax:631-920-8463
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor