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General NPI Number Information
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NPI Number | 1154766350
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Entity Type | Organization
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Legal Business Name | SERENITY ZONE LCSW PLLC
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 4025 AUSTIN BLVD
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City | ISLAND PARK
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State | NY
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Zip | 11558-1221
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Country | US
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Telephone | 516-432-1790
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Fax | 516-432-0760
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Provider Business Mailing Address
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Address Line | 4025 AUSTIN BLVD
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City | ISLAND PARK
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State | NY
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Zip | 11558-1221
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Country | US
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Telephone | 516-432-1790
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Fax | 516-432-0760
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Authorized Official
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Title or Position | SECRETARY
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Name | JEFF CORNATZOR
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Credential | CSMC
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Telephone | 516-432-1790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 074680-1
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License Number State | NY
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