Provider Demographics
NPI:1164757787
Name:SOCIAL WORK FOR COUNSELING FOR INSPIRATIONAL LIVING LCSW PC
Entity Type:Organization
Organization Name:SOCIAL WORK FOR COUNSELING FOR INSPIRATIONAL LIVING LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:LENT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-474-1533
Mailing Address - Street 1:6 ROOSEVELT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3364
Mailing Address - Country:US
Mailing Address - Phone:631-474-1533
Mailing Address - Fax:631-474-1533
Practice Address - Street 1:6 ROOSEVELT AVE STE 2
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3364
Practice Address - Country:US
Practice Address - Phone:631-474-1533
Practice Address - Fax:631-474-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048202-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364309Medicaid
NYN6V781Medicare UPIN