Healthcare Provider Details

I. General information

NPI: 1881441434
Provider Name (Legal Business Name): METAMORPHOSIS, LMSW P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COLONIAL SPRINGS RD
WHEATLEY HEIGHTS NY
11798-1015
US

IV. Provider business mailing address

51 PUTNAM AVE
WEST BABYLON NY
11704-1807
US

V. Phone/Fax

Practice location:
  • Phone: 631-229-3688
  • Fax: 631-229-3689
Mailing address:
  • Phone: 631-219-6598
  • Fax: 631-229-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERYL MCHUNGUZI
Title or Position: OWNER CEO
Credential: LMSW
Phone: 631-219-6598