=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942757273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADINA SARA TABOR LCSW, LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2016
-----------------------------------------------------
Last Update Date | 04/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 HALLOCK AVE RM 102
-----------------------------------------------------
City | PORT JEFFERSON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11776-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-282-5590
-----------------------------------------------------
Fax | 856-320-9854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 U ST NW APT 212
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20009-7943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-505-6283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 093897
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 088375
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------