Provider Demographics
NPI:1073901500
Name:LYNNE SLOVIN
Entity Type:Organization
Organization Name:LYNNE SLOVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:516-810-5690
Mailing Address - Street 1:63 ADMIRALS DR E
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8100
Mailing Address - Country:US
Mailing Address - Phone:516-810-5690
Mailing Address - Fax:
Practice Address - Street 1:63 ADMIRALS DR E
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8100
Practice Address - Country:US
Practice Address - Phone:516-810-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073101-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)