Provider Demographics
NPI:1164565743
Name:FLORY, SHARON POLTUN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:POLTUN
Last Name:FLORY
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 1:207 W 86TH ST
Mailing Address - Street 2:APT. 215
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3341
Mailing Address - Country:US
Mailing Address - Phone:212-877-6436
Mailing Address - Fax:212-877-6436
Practice Address - Street 1:207 W 86TH ST
Practice Address - Street 2:APT. 215
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3341
Practice Address - Country:US
Practice Address - Phone:212-877-6436
Practice Address - Fax:212-877-6436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY482519OtherVALUE OPTIONS PROVIDER ID
NY7351661OtherGHI PROVIDER ID
NYP2590807OtherOXFORD PROVIDER ID