Provider Demographics
NPI:1083397400
Name:SERRANO, KEONA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KEONA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HUGUENOT ST APT 708
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7013
Mailing Address - Country:US
Mailing Address - Phone:518-332-5931
Mailing Address - Fax:
Practice Address - Street 1:360 HUGUENOT ST APT 708
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7013
Practice Address - Country:US
Practice Address - Phone:518-332-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0920051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty