Healthcare Provider Details

I. General information

NPI: 1316037443
Provider Name (Legal Business Name): JENNIFER LYNN SOKOLOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FLOWERFIELD
SAINT JAMES NY
11780-1500
US

IV. Provider business mailing address

21 BROOKVALE LN
LAKE GROVE NY
11755-2708
US

V. Phone/Fax

Practice location:
  • Phone: 631-920-8500
  • Fax: 631-920-8501
Mailing address:
  • Phone: 631-588-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: