Organization
BUTTERFLY LCSW PC
Active
Other names
Jean Bacon
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN BACON PHD, LCSW (CLINICAL DIRECTOR)
(631) 666-5067
Entity
Organization
Contact information
Practice address
83 E MAIN ST, BAY SHORE, NY 11706-8305
(631) 666-5067
(631) 593-5472
Mailing address
34 FIRE ROAD DR, BAY SHORE, NY 11706-3947
(631) 666-1951
(631) 593-5472
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
070271
NY
104100000X
Social Worker
070508
NY
104100000X
Social Worker
073889
NY
104100000X
Social Worker
074014
NY
104100000X
Social Worker
074277
NY
104100000X
Social Worker
075977
NY
104100000X
Social Worker
076163
NY
104100000X
Social Worker
076780
NY
104100000X
Social Worker
077805
NY
104100000X
Social Worker
077806
NY
104100000X
Social Worker
079274
NY
104100000X
Social Worker
079551
NY
1041C0700X
Clinical Social Worker
Primary
04056
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100024503
MEDICARE GROUP PTAN
NY
Enumeration date
01/27/2010
Last updated
04/14/2020
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