Healthcare Provider Details

I. General information

NPI: 1154833119
Provider Name (Legal Business Name): ADRIANA OGNIBENE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 ATHENS AVE
DURHAM NC
27707-4312
US

IV. Provider business mailing address

1708 ATHENS AVE
DURHAM NC
27707-4312
US

V. Phone/Fax

Practice location:
  • Phone: 516-670-4219
  • Fax:
Mailing address:
  • Phone: 516-670-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: