Healthcare Provider Details

I. General information

NPI: 1063921344
Provider Name (Legal Business Name): RENA LEE SEMERTZIDIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GRAND AVENUE
BALDWIN NY
11510
US

IV. Provider business mailing address

2277 GRAND AVE
BALDWIN NY
11510-3148
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-5400
  • Fax: 516-377-5490
Mailing address:
  • Phone: 516-377-5400
  • Fax: 516-377-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: