Provider Demographics
NPI:1558422519
Name:PERRY, DAVID IVAN (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IVAN
Last Name:PERRY
Suffix:
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 BOND ST
Mailing Address - Street 2:SUITE #1CA
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2414
Mailing Address - Country:US
Mailing Address - Phone:516-482-3361
Mailing Address - Fax:516-482-3361
Practice Address - Street 1:7 BOND ST
Practice Address - Street 2:SUITE #1CA
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2414
Practice Address - Country:US
Practice Address - Phone:516-482-3361
Practice Address - Fax:516-482-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026866-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical