Provider Demographics
NPI:1376622605
Name:SENREICH, EVAN IRA (MSW LCSW ACSW)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:IRA
Last Name:SENREICH
Suffix:
Gender:M
Credentials:MSW LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 TAYLOR STREET
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:212-642-8594
Mailing Address - Fax:212-689-7745
Practice Address - Street 1:110 21 73RD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:212-642-8594
Practice Address - Fax:212-689-7745
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03907011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOI921OtherMEDICARE MANHATTAN
NYNOI921OtherMEDICARE MANHATTAN
R89387Medicare UPIN