Healthcare Provider Details

I. General information

NPI: 1114521663
Provider Name (Legal Business Name): DINA JACQUELINE SASSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 FRONT ST
HEMPSTEAD NY
11550-4627
US

IV. Provider business mailing address

2828 KINGS HWY APT 3F
BROOKLYN NY
11229-1854
US

V. Phone/Fax

Practice location:
  • Phone: 718-506-1115
  • Fax:
Mailing address:
  • Phone: 917-589-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073517-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: