Provider Demographics
NPI:1518078773
Name:FERTILITY AND FAMILY LIFE COUNSELING
Entity Type:Organization
Organization Name:FERTILITY AND FAMILY LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW,BCD
Authorized Official - Prefix:MS
Authorized Official - First Name:AVIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-625-1617
Mailing Address - Street 1:445 NORTHERN BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-625-1617
Mailing Address - Fax:516-625-1617
Practice Address - Street 1:445 NORTHERN BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-625-1617
Practice Address - Fax:516-625-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019157-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty