Facts
- Status
- A
- Credential
- L.C.S.W.
- Type
- Individual
- Enumeration date
- 2006-06-21
- Last updated
- 2026-07-13
Specialties
Licenses
- License NY
- PR015508-1LCSW
Location
- Practice location
- 14 HIGHVIEW BLVD
- City
- BROOKHAVEN NY
- Postal code
- 117199729
- Phone
- 631-580-9209
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.