Healthcare Provider Details

I. General information

NPI: 1821190414
Provider Name (Legal Business Name): ORENE W. ESPOSITO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LAKE AVE SUITE 1
SAINT JAMES NY
11780-2255
US

IV. Provider business mailing address

2 SANDY ST
EAST NORTHPORT NY
11731-5421
US

V. Phone/Fax

Practice location:
  • Phone: 631-766-6791
  • Fax: 631-423-3230
Mailing address:
  • Phone: 631-271-0964
  • Fax: 631-423-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR041826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: