Provider Demographics
NPI:1952395089
Name:UREKE, MIRCA MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MIRCA
Middle Name:MICHAEL
Last Name:UREKE
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 1:298 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 FREER ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2816
Practice Address - Country:US
Practice Address - Phone:516-209-1303
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053804-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02631703Medicaid
NYN02Z01Medicare ID - Type Unspecified