| Catherine Provenzano | |
|
1050 Hallock Ave Port Jefferson Station NY 11776-1214 | |
| (631) 487-5162 | |
| Not Available |
| Full Name | Catherine Provenzano |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1050 Hallock Ave, Port Jefferson Station, New York |
| Authorized Official Name and Position | Catherine Provenzano (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6314875162 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Catherine Provenzano 1050 Hallock Ave Port Jefferson Station NY 11776-1214 Ph: (631) 487-5162 | Catherine Provenzano 1050 Hallock Ave Port Jefferson Station NY 11776-1214 Ph: (631) 487-5162 |
| NPI Number | 1669875936 |
|---|---|
| Provider Enumeration Date | 10/01/2014 |
| Last Update Date | 10/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669875936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 081438 (New York) | Primary |
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