Healthcare Provider Details

I. General information

NPI: 1326523374
Provider Name (Legal Business Name): SUZANNE SORRENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3510
US

IV. Provider business mailing address

2631 MERRICK RD STE 302
BELLMORE NY
11710-5784
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: