Provider Demographics
NPI:1437201498
Name:LENT, KENNETH G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:G
Last Name:LENT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048202-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY205295POtherHIP
NY092104OtherVALUE OPTIONS
NY140237OtherVYTRA
NY561724000OtherMAGELLAN
NYP3557347OtherOXFORD
NY6224668OtherUNITED BEHAVIORAL HEALTH
NY7336342OtherGHI
NY60054OtherAETNA
NY02364309Medicaid
NY02364309Medicaid