Provider Demographics
NPI:1518977107
Name:NUNAN, AIDEEN MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AIDEEN
Middle Name:MARY
Last Name:NUNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 54TH ST
Mailing Address - Street 2:6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4957
Mailing Address - Country:US
Mailing Address - Phone:212-688-0187
Mailing Address - Fax:
Practice Address - Street 1:345 E 54TH ST
Practice Address - Street 2:6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4957
Practice Address - Country:US
Practice Address - Phone:212-688-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYROO75461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2790463OtherOXFORD NETWORK
NYN20041Medicare ID - Type Unspecified