Healthcare Provider Details

I. General information

NPI: 1932577301
Provider Name (Legal Business Name): RAMIN AZARM LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WAVERLY AVE STE 11
PATCHOGUE NY
11772-1555
US

IV. Provider business mailing address

21 GROVE DR
MASTIC NY
11950-1603
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 Number089408-1
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: