Doctor Name: | MRS. KIRA M MANTELL |
NPI Number: | 1447492632 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 079313 |
Business Practice Address: | 445 Oak St Copiague, NY - 117263111 |
Business Phone Number: | 6316917080 |
Business Fax Number: | |
Mailing Address: | 20 Gilbert Ave, Suite 101 SMITHTOWN |
State: | NY |
Postal Code: | 117875326 |
Phone Number: | 5165102759 |
Fax Number: | 6317806349 |
NPI Enumeration Date: | 04/02/2009 |
NPI Last Update Date: | 01/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 079313 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |