Provider Demographics
NPI:1780715508
Name:HAJISAVA, IRENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:HAJISAVA
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 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 91
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-294-0411
Mailing Address - Fax:516-294-8532
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE 91
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-294-0411
Practice Address - Fax:516-294-8532
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR02274711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical