MEDICARE: DRAGONFLY LCSW, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1639548316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGONFLY LCSW, PLLC

Provider Business Mailing Address
First Line	:	51 OSBORNE AVE
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-3134
Country	:	US
Telephone Number	:	631-642-3351
Fax Number	:	631-642-3351

Provider Business Practice Location Address
First Line	:	51 OSBORNE AVE
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-3134
Country	:	US
Telephone Number	:	631-642-3351
Fax Number	:	631-642-3351

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	IVONNE M ROMERO
Credential	:	LCSW-R
Telephone Number	:	631-642-3351

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	02/07/2023

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