Provider Demographics
NPI:1275650533
Name:VANASSEN, WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VANASSEN
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 1:21 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4012
Mailing Address - Country:US
Mailing Address - Phone:631-591-2956
Mailing Address - Fax:
Practice Address - Street 1:21 GLEN AVE
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NY
Practice Address - Zip Code:11901-4012
Practice Address - Country:US
Practice Address - Phone:631-591-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0724111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical