Healthcare Provider Details

I. General information

NPI: 1124499470
Provider Name (Legal Business Name): THOMAS HLENSKI D.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RICHARD LANE
HUNTINGTON NY
11743
US

IV. Provider business mailing address

4 RICHARD LANE
HUNTINGTON NY
11743
US

V. Phone/Fax

Practice location:
  • Phone: 631-423-1733
  • Fax:
Mailing address:
  • Phone: 631-423-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR016669-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: