Healthcare Provider Details

I. General information

NPI: 1477429397
Provider Name (Legal Business Name): CORINNE VAZAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/24/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MIDDLE COUNTRY RD
SMITHTOWN NY
11787-2978
US

IV. Provider business mailing address

285 MIDDLE COUNTRY RD
SMITHTOWN NY
11787-2978
US

V. Phone/Fax

Practice location:
  • Phone: 631-724-0600
  • Fax:
Mailing address:
  • Phone: 631-724-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: