Healthcare Provider Details

I. General information

NPI: 1629478128
Provider Name (Legal Business Name): SABRINA SPOTORNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 A SOUTH STREET
OYSTER BAY NY
11771
US

IV. Provider business mailing address

193 A SOUTH STREET
OYSTER BAY NY
11771
US

V. Phone/Fax

Practice location:
  • Phone: 631-903-9532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088976
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: