Provider Demographics
NPI:1578136842
Name:MEYERS, BAMBINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BAMBINA
Middle Name:
Last Name:MEYERS
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 1:5 ST LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:10527-1017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 ST LEONARD AVE
Practice Address - Street 2:
Practice Address - City:GRANITE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:10527-1017
Practice Address - Country:US
Practice Address - Phone:914-493-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0876351041C0700X
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical