=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164025706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NINA SASSO LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2020
-----------------------------------------------------
Last Update Date | 11/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1226 W BROADWAY STE 5
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-558-3010
-----------------------------------------------------
Fax | 516-558-3011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1226 W BROADWAY STE 5
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-558-3010
-----------------------------------------------------
Fax | 516-558-3011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 074059
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------