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General NPI Number Information
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NPI Number | 1982299897
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Entity Type | Individual
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Provider Name | CHRISTOPHER E LOGLIA LCSW, CASAC
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Gender | Male
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 23 DEWEY ST
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1421
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Country | US
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Telephone | 631-942-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 23 DEWEY ST
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1421
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Country | US
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Telephone | 631-942-7121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 34488
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 1265042181
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 095457-01
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License Number State | NY
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