Provider Demographics
NPI:1336281047
Name:COVITZ, ANN L (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:L
Last Name:COVITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2004
Mailing Address - Country:US
Mailing Address - Phone:631-928-9397
Mailing Address - Fax:631-928-9397
Practice Address - Street 1:100 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2004
Practice Address - Country:US
Practice Address - Phone:631-928-9397
Practice Address - Fax:631-928-9397
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034812R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical