Provider Demographics
NPI:1477253177
Name:PHOENIX, NADIE (LMSW)
Entity Type:Individual
Prefix:
First Name:NADIE
Middle Name:
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5635
Mailing Address - Country:US
Mailing Address - Phone:607-274-6234
Mailing Address - Fax:
Practice Address - Street 1:201 E GREEN ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5635
Practice Address - Country:US
Practice Address - Phone:607-274-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118864104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker