Healthcare Provider Details

I. General information

NPI: 1912779349
Provider Name (Legal Business Name): COLIN HENRY YACCARINO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 KNOLLWOOD RD
HUNTINGTON NY
11743-1551
US

IV. Provider business mailing address

58 KNOLLWOOD RD
HUNTINGTON NY
11743-1551
US

V. Phone/Fax

Practice location:
  • Phone: 631-335-3315
  • Fax:
Mailing address:
  • Phone: 631-335-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: