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General NPI Number Information
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NPI Number | 1992217871
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Entity Type | Organization
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Legal Business Name | ERICA ZELLER LICENSED CLINICAL SOCIAL WORK PLLC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 15 BELLEMEADE AVE STE 3
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-863-9223
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Fax | 631-406-6444
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Provider Business Mailing Address
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Address Line | 25 ROUTE 111 UNIT 1210
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City | SMITHTOWN
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State | NY
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Zip | 11787-7049
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Country | US
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Telephone | 631-863-9223
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Fax | 631-406-6444
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Authorized Official
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Title or Position | OWNER
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Name | ERICA ZELLER
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Credential | LCSW
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Telephone | 631-863-9223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 085957
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License Number State | NY
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