Provider Demographics
NPI:1255439212
Name:NEMIROFF, DAVID AARON (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:AARON
Last Name:NEMIROFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TREE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6315
Mailing Address - Country:US
Mailing Address - Phone:631-595-2839
Mailing Address - Fax:
Practice Address - Street 1:106 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3844
Practice Address - Country:US
Practice Address - Phone:631-804-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05102081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY078465OtherVALUE OPTIONS
NY02075354Medicaid
NY02075354Medicaid