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Individual
ELLEN SIMON IRVING
Active
Individual
ELLEN SIMON IRVING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R040080-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R040080
NYS LICENSE
NY
Enumeration date
10/11/2006
Last updated
03/05/2010
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