| Social Work For Counseling For Inspirational Living Lcsw Pc | |
|
6 Roosevelt Ave Ste 2 Port Jefferson Station NY 11776-3364 | |
| (631) 474-1533 | |
| (631) 474-1533 |
| Full Name | Social Work For Counseling For Inspirational Living Lcsw Pc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 6 Roosevelt Ave Ste 2, Port Jefferson Station, New York |
| Authorized Official Name and Position | Kenneth G. Lent (OWNER) |
| Authorized Official Contact | 6314741533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Social Work For Counseling For Inspirational Living Lcsw Pc 6 Roosevelt Ave Ste 2 Port Jefferson Station NY 11776-3364 Ph: (631) 474-1533 | Social Work For Counseling For Inspirational Living Lcsw Pc 6 Roosevelt Ave Ste 2 Port Jefferson Station NY 11776-3364 Ph: (631) 474-1533 |
| NPI Number | 1164757787 |
|---|---|
| Provider Enumeration Date | 10/15/2009 |
| Last Update Date | 05/16/2019 |
| Medicare PECOS PAC ID | 9133307986 |
|---|---|
| Medicare Enrollment ID | O20190508000785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164757787 | NPI | - | NPPES |
| 02364309 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | R048202-1 (New York) | Primary |
| Provider Name | Kenneth Lent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437201498 PECOS PAC ID: 1355487158 Enrollment ID: I20091008000376 |
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