Provider Demographics
NPI:1093909376
Name:SOSNOWSKI, MARYLOU (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARYLOU
Middle Name:
Last Name:SOSNOWSKI
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 1:60 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3533
Mailing Address - Country:US
Mailing Address - Phone:631-470-0439
Mailing Address - Fax:631-369-0130
Practice Address - Street 1:298 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2034
Practice Address - Country:US
Practice Address - Phone:631-369-1234
Practice Address - Fax:631-369-0130
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074054-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical