Healthcare Provider Details

I. General information

NPI: 1275450561
Provider Name (Legal Business Name): SANDRA SOFIA MERINO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HENRY DR
GLEN COVE NY
11542-1708
US

IV. Provider business mailing address

22 HENRY DR
GLEN COVE NY
11542-1708
US

V. Phone/Fax

Practice location:
  • Phone: 516-279-7809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: