Provider Demographics
NPI:1235444076
Name:IBRAHIM, NERMINE (MS)
Entity Type:Individual
Prefix:
First Name:NERMINE
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PHAETONS DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2024
Mailing Address - Country:US
Mailing Address - Phone:631-423-1098
Mailing Address - Fax:
Practice Address - Street 1:2 PHAETONS DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2024
Practice Address - Country:US
Practice Address - Phone:631-423-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002236101YM0800X
NY1103844103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health