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General NPI Number Information
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NPI Number | 1164757787
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Entity Type | Organization
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Legal Business Name | SOCIAL WORK FOR COUNSELING FOR INSPIRATIONAL LIVING LCSW PC
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 6 ROOSEVELT AVE STE 2
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3364
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Country | US
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Telephone | 631-474-1533
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Fax | 631-474-1533
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Provider Business Mailing Address
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Address Line | 6 ROOSEVELT AVE STE 2
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3364
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Country | US
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Telephone | 631-474-1533
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Fax | 631-474-1533
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Authorized Official
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Title or Position | OWNER
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Name | MR. KENNETH G. LENT
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Credential | LCSW
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Telephone | 631-474-1533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | R048202-1
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License Number State | NY
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