Healthcare Provider Details

I. General information

NPI: 1497020655
Provider Name (Legal Business Name): GERALDINE LANDRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD ORANGEBURG ROAD
ORANGEBURG NY
10962
US

IV. Provider business mailing address

45 ASHLEY AVENUE
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-1000
  • Fax: 845-680-5580
Mailing address:
  • Phone: 845-343-6686
  • Fax: 845-326-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR031964-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: