Provider Demographics
NPI:1477210698
Name:SARDONYX WELLNESS LCSW PLLC
Entity Type:Organization
Organization Name:SARDONYX WELLNESS LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT-BROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-509-2575
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-0822
Mailing Address - Country:US
Mailing Address - Phone:631-509-2575
Mailing Address - Fax:631-256-9353
Practice Address - Street 1:93 MAIN ST STE 1J
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1832
Practice Address - Country:US
Practice Address - Phone:631-509-2575
Practice Address - Fax:631-256-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty