Provider Demographics
NPI:1659418390
Name:PRICE LERNER, PAMELA L (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:PRICE LERNER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5021
Mailing Address - Country:US
Mailing Address - Phone:516-349-1708
Mailing Address - Fax:516-349-1708
Practice Address - Street 1:1120 OLD COUNTRY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5021
Practice Address - Country:US
Practice Address - Phone:516-349-1708
Practice Address - Fax:516-349-1708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053374104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02470506Medicaid
NY197645OtherMHN
106648OtherVALUE OPTIONS
136829OtherVYTRA
NY197645OtherMHN
NY113406511OtherHIP TAX ID NUMBER