Healthcare Provider Details

I. General information

NPI: 1386019719
Provider Name (Legal Business Name): PATRICIA TERMINI-GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 4TH AVE
BAY SHORE NY
11706-7908
US

IV. Provider business mailing address

81 ELDER RD
ISLIP NY
11751-4910
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-6707
  • Fax:
Mailing address:
  • Phone: 631-827-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number068436-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095979-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: