Healthcare Provider Details

I. General information

NPI: 1336182682
Provider Name (Legal Business Name): SANDRA A DACUNHA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OAK ST SUITE 27
PATCHOGUE NY
11772-2887
US

IV. Provider business mailing address

11 MAPLE AVE
HOLBROOK NY
11741-1801
US

V. Phone/Fax

Practice location:
  • Phone: 631-569-4688
  • Fax: 631-569-4688
Mailing address:
  • Phone: 631-569-4688
  • Fax: 631-569-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR-039999-1
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: