Provider Demographics
NPI:1780159392
Name:IVES, VANESSA R (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:R
Last Name:IVES
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:R
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:27 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7892
Mailing Address - Country:US
Mailing Address - Phone:518-744-8904
Mailing Address - Fax:
Practice Address - Street 1:27 ESSEX CT
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-7892
Practice Address - Country:US
Practice Address - Phone:518-744-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12719721811041S0200X
NY077514-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool