Healthcare Provider Details

I. General information

NPI: 1689037574
Provider Name (Legal Business Name): SILVER LININGS A SAFE HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST SUITE 102
PATCHOGUE NY
11772-3121
US

IV. Provider business mailing address

88 BROOKFIELD AVE
CENTER MORICHES NY
11934-2221
US

V. Phone/Fax

Practice location:
  • Phone: 631-905-6884
  • Fax: 631-909-2629
Mailing address:
  • Phone: 631-905-6884
  • Fax: 631-909-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0044521
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SUE ANN FRATELLO
Title or Position: SOLE PROPRIETOR
Credential: LMHC
Phone: 631-905-6884