Healthcare Provider Details

I. General information

NPI: 1669456091
Provider Name (Legal Business Name): SHARON LYN ZARIELLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E BROADWAY
PORT JEFFERSON NY
11777-1400
US

IV. Provider business mailing address

152 AVENUE B
HOLBROOK NY
11741-1409
US

V. Phone/Fax

Practice location:
  • Phone: 631-642-9525
  • Fax: 631-642-9525
Mailing address:
  • Phone: 631-642-9525
  • Fax: 631-642-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number049107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: