Healthcare Provider Details

I. General information

NPI: 1972701886
Provider Name (Legal Business Name): SHARON FAY SOLINA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MAIN ST
PATCHOGUE NY
11772-3159
US

IV. Provider business mailing address

25 E MASEM SQ
EAST PATCHOGUE NY
11772-5607
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-2851
  • Fax:
Mailing address:
  • Phone: 631-848-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR045721-1
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: