Provider Demographics
NPI:1003055096
Name:SILVER LAKE PSYCHOTHERAPY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SILVER LAKE PSYCHOTHERAPY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SGARLATO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-667-0131
Mailing Address - Street 1:1036 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3622
Mailing Address - Country:US
Mailing Address - Phone:718-727-3313
Mailing Address - Fax:718-667-0131
Practice Address - Street 1:1036 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3622
Practice Address - Country:US
Practice Address - Phone:718-727-3313
Practice Address - Fax:718-667-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty