Provider Demographics
NPI:1588616619
Name:AHERN-SAMMON, JOAN-MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN-MARY
Middle Name:
Last Name:AHERN-SAMMON
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 1:69 REID AVE
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1202
Mailing Address - Country:US
Mailing Address - Phone:718-318-9048
Mailing Address - Fax:718-630-2950
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:122
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-630-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039792-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN75071Medicare ID - Type Unspecified