Provider Demographics
NPI:1639409600
Name:WERNER, GARRY MARC (LCSW-P)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:MARC
Last Name:WERNER
Suffix:
Gender:M
Credentials:LCSW-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 LAWRENCE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1752
Mailing Address - Country:US
Mailing Address - Phone:516-659-4093
Mailing Address - Fax:516-328-7236
Practice Address - Street 1:59 LAWRENCE STREET
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1752
Practice Address - Country:US
Practice Address - Phone:516-659-4093
Practice Address - Fax:516-328-7236
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP065154-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN577V1Medicare PIN