Healthcare Provider Details

I. General information

NPI: 1114432630
Provider Name (Legal Business Name): KELLI SORANNO LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 ROANOKE AVENUE
RIVERHEAD NY
11901
US

IV. Provider business mailing address

565 ROUTE 25A STE 202
MILLER PLACE NY
11764-2665
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-0022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: