Healthcare Provider Details

I. General information

NPI: 1053227017
Provider Name (Legal Business Name): MR. LOUIS THOMAS DEMARTINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 PARK LN S APT 1H
WOODHAVEN NY
11421-1265
US

IV. Provider business mailing address

8620 PARK LN S APT 1H
WOODHAVEN NY
11421-1265
US

V. Phone/Fax

Practice location:
  • Phone: 917-435-3895
  • Fax:
Mailing address:
  • Phone: 917-435-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: