Healthcare Provider Details

I. General information

NPI: 1699599746
Provider Name (Legal Business Name): CALMING WATERS LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 WESTVIEW DR
MATTITUCK NY
11952-2950
US

IV. Provider business mailing address

PO BOX 1228
MATTITUCK NY
11952-0922
US

V. Phone/Fax

Practice location:
  • Phone: 631-655-5171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA MOSCATO
Title or Position: OWNER
Credential:
Phone: 631-655-5171