Provider Demographics
NPI:1053378208
Name:LE VAR, JOAN PHYLLIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:PHYLLIS
Last Name:LE VAR
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:333 EAST 79THE STREET
Mailing Address - Street 2:#9N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:914-924-0416
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:227 MADISON STREET
Practice Address - Street 2:GOUVERNEUR HEALTHCARE SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-238-7301
Practice Address - Fax:212-238-7399
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0759861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY075986OtherNYS LICENSE
NYA400015544Medicare PIN