Provider Demographics
NPI:1902471162
Name:SOMER, JONATHAN (LMSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SOMER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2356
Mailing Address - Country:US
Mailing Address - Phone:845-225-2700
Mailing Address - Fax:845-225-5828
Practice Address - Street 1:1808 ROUTE 6
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2356
Practice Address - Country:US
Practice Address - Phone:845-225-2700
Practice Address - Fax:845-225-5828
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111372-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker