Provider Demographics
NPI:1164093209
Name:LENGYEL, REBECCA LENORE D (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LENORE D
Last Name:LENGYEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SPACE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2282
Mailing Address - Country:US
Mailing Address - Phone:631-258-2093
Mailing Address - Fax:
Practice Address - Street 1:5 SPACE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2282
Practice Address - Country:US
Practice Address - Phone:631-258-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker