Provider Demographics
NPI:1629169917
Name:EMERY, PRUDENCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PRUDENCE
Middle Name:
Last Name:EMERY
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 1:617 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3411
Mailing Address - Country:US
Mailing Address - Phone:516-621-4878
Mailing Address - Fax:516-292-7237
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:RM 1401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5034
Practice Address - Country:US
Practice Address - Phone:212-362-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0116221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0065850OtherGHI
0065850OtherGHI
N03162Medicare ID - Type Unspecified