Provider Demographics
NPI:1801814900
Name:BIRDSALL, NANCY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:BIRDSALL
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 1:66 CAROLINE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-5019
Mailing Address - Country:US
Mailing Address - Phone:516-825-3019
Mailing Address - Fax:516-825-3019
Practice Address - Street 1:66 CAROLINE AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-5019
Practice Address - Country:US
Practice Address - Phone:516-825-3019
Practice Address - Fax:516-825-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO13952-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN25941Medicare ID - Type Unspecified