Healthcare Provider Details

I. General information

NPI: 1508632340
Provider Name (Legal Business Name): RAMIN AZARM LCSW P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WAVERLY AVE STE 11
PATCHOGUE NY
11772-1555
US

IV. Provider business mailing address

450 WAVERLY AVE STE 11
PATCHOGUE NY
11772-1555
US

V. Phone/Fax

Practice location:
  • Phone: 631-618-5940
  • Fax:
Mailing address:
  • Phone: 631-618-5940
  • 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: MR. RAMIN ADRIAN AZARM
Title or Position: OWNER
Credential: LCSW
Phone: 631-618-5940