Healthcare Provider Details

I. General information

NPI: 1407902455
Provider Name (Legal Business Name): MICHELE A CIPRIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 RTE 25A SUITE5
ROCKY POINT NY
11778-9089
US

IV. Provider business mailing address

22 DOGWOOD RD
ROCKY POINT NY
11778-8917
US

V. Phone/Fax

Practice location:
  • Phone: 516-297-0704
  • Fax: 631-849-4522
Mailing address:
  • Phone: 516-297-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP053974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: