Provider Demographics
NPI:1568485704
Name:FLUM, JOAN W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:W
Last Name:FLUM
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 1:100 CARLYLE PL
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1206
Mailing Address - Country:US
Mailing Address - Phone:516-625-8424
Mailing Address - Fax:516-625-8424
Practice Address - Street 1:100 CARLYLE PL
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1206
Practice Address - Country:US
Practice Address - Phone:516-625-8424
Practice Address - Fax:516-625-8424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028014302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization