Healthcare Provider Details

I. General information

NPI: 1568594059
Provider Name (Legal Business Name): SANDRA MILENA CETINA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 62ND ST
WOODSIDE NY
11377-5098
US

IV. Provider business mailing address

PO BOX 580095
FLUSHING NY
11358-0095
US

V. Phone/Fax

Practice location:
  • Phone: 718-476-0076
  • Fax:
Mailing address:
  • Phone: 646-660-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: