Provider Demographics
NPI:1720060403
Name:PHILBIN, JANET SHERYL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:SHERYL
Last Name:PHILBIN
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 1:36 DERBY PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1328
Mailing Address - Country:US
Mailing Address - Phone:516-639-6286
Mailing Address - Fax:631-979-3710
Practice Address - Street 1:155 E. MAIN STREET
Practice Address - Street 2:SUITE 170
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2832
Practice Address - Country:US
Practice Address - Phone:516-639-6286
Practice Address - Fax:631-979-3710
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043258-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2482807OtherOXFORD PROVIDER NUMBER
NY7108202OtherAETNA PROVIDER NUMBER
NY7482941OtherGHI PROVIDER NUMBER
NYNF4581Medicare ID - Type UnspecifiedPROVIDER ID