Healthcare Provider Details

I. General information

NPI: 1699063008
Provider Name (Legal Business Name): DANIEL DERIENZIS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE 309
HEMPSTEAD NY
11550-3718
US

IV. Provider business mailing address

233 8TH AVE
SEA CLIFF NY
11579-1103
US

V. Phone/Fax

Practice location:
  • Phone: 516-485-5710
  • Fax: 516-485-4225
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number075471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: