Provider Demographics
NPI:1831208842
Name:ALTSCHUL, MERCEDES A (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:A
Last Name:ALTSCHUL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TALON WAY
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6239
Mailing Address - Country:US
Mailing Address - Phone:631-667-6673
Mailing Address - Fax:631-254-2345
Practice Address - Street 1:15 HORSEBLOCK PL
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1204
Practice Address - Country:US
Practice Address - Phone:631-854-2552
Practice Address - Fax:631-854-2550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0756581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY063082OtherSOCIAL WORK LICENSE
NY063082OtherSOCIAL WORK LICENSE