Provider Demographics
NPI:1851546154
Name:DRUCK, BEVERLY GOLDSMITH (MSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:GOLDSMITH
Last Name:DRUCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W END AVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2713
Mailing Address - Country:US
Mailing Address - Phone:212-595-7395
Mailing Address - Fax:212-595-1629
Practice Address - Street 1:545 W END AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2713
Practice Address - Country:US
Practice Address - Phone:212-595-7395
Practice Address - Fax:212-595-1629
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO15307-1104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker