Healthcare Provider Details

I. General information

NPI: 1134067259
Provider Name (Legal Business Name): KAMILA KULAKOWSKA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 OLD SOUTH COUNTRY RD
BROOKHAVEN NY
11719-9527
US

IV. Provider business mailing address

40 OLD SOUTH COUNTRY RD
BROOKHAVEN NY
11719-9527
US

V. Phone/Fax

Practice location:
  • Phone: 631-466-4885
  • Fax:
Mailing address:
  • Phone: 631-466-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: