Provider Demographics
NPI:1275604936
Name:MUNRO, DAVID ANGUS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANGUS
Last Name:MUNRO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722
Mailing Address - Country:US
Mailing Address - Phone:631-234-0236
Mailing Address - Fax:631-234-0286
Practice Address - Street 1:129 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722
Practice Address - Country:US
Practice Address - Phone:631-234-0236
Practice Address - Fax:631-234-0286
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01566611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R45492Medicare UPIN
N01051Medicare ID - Type Unspecified