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General NPI Number Information
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NPI Number | 1053927137
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Entity Type | Individual
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Provider Name | BETTE JAYNE TROJANOWSKI
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Gender | Female
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 1394 ROANOKE AVE STE A
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City | RIVERHEAD
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State | NY
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Zip | 11901-2100
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Country | US
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Telephone | 631-257-7968
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | JAMESPORT
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State | NY
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Zip | 11947-0356
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Country | US
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Telephone | 631-566-6430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105367
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 012016-1
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License Number State | NY
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