Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mia Ivancovich

Individual provider Addiction (Substance Use Disorder) Registered Nurse · NPI 1487467957

Mia Ivancovich is an Addiction (Substance Use Disorder) Registered Nurse in Brentwood, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2025
Specialties on file
2

Practice location Address checks out

452 Suffolk Ave
Brentwood, NY 11717-4214
Phone: (631) 436-6065
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 813227-01 (NY)
Addiction (Substance Use Disorder) Registered Nurse Taxonomy 163WA0400X · Licence 813227-01 (NY)

Record details

NPI number1487467957
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 29, 2025
Last updated in NPPESJanuary 29, 2025
Certification dateJanuary 29, 2025
Mailing address67 Millay Ln, Bay Shore, NY 11706-4329

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