MEDICARE: NINA SASSO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker
2	1041C0700X	Clinical Social Worker	074059	NY

General Provider Information

NPI Number	:	1164025706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA SASSO LCSW

Provider Business Mailing Address
First Line	:	1226 W BROADWAY STE 5
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1923
Country	:	US
Telephone Number	:	516-558-3010
Fax Number	:	516-558-3011

Provider Business Practice Location Address
First Line	:	1226 W BROADWAY STE 5
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1923
Country	:	US
Telephone Number	:	516-558-3010
Fax Number	:	516-558-3011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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