Ilene Robin Augenlicht, LCSW
Individual provider Active NPI Clinical Social Worker · Centereach, NY
NPI 1124177472 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124177472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- R040417-1 (NY)
- Practice address
- 2539 Middle Country Rd
Suite 4
Centereach, NY 11720-3551 - Phone
- (631) 467-3848
- Fax
- (631) 451-4660
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R040417-1 | NY | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R040417-1 | NY | Yes |
Addresses
Primary practice location
2539 Middle Country Rd
Suite 4
Centereach, NY 11720-3551
Mailing address
28 Forrest Ave
Centereach, NY 11720-3639
Phone (631) 467-3848
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02024739 | Medicaid | NY |
Other providers in Centereach, NY
- Apex Imaging and Services LLC
- Koren C Arevalo
- Lisa Ann Artale
- Eva Asamoah
- Katherine Atatsi
- Malak Ishak Azab
- Wendy Jean Azmoun
- Carolyn Barravecchio
- Shannon Barresi
- Danielle Leigh Barrington
All providers in Centereach, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.