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

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