=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821851577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERRI KOSLOFF LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2024
-----------------------------------------------------
Last Update Date | 02/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 E CARVER ST
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-609-0754
-----------------------------------------------------
Fax | 631-673-5435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 E CARVER ST
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-609-0754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KERRI KOSLOFF
-----------------------------------------------------
Credential | LCSW-R
-----------------------------------------------------
Telephone | 631-609-0754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------