Provider Demographics
NPI:1477225316
Name:DAVINCI THERAPY SERVICES, LCSW, PLLC
Entity Type:Organization
Organization Name:DAVINCI THERAPY SERVICES, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSAK
Authorized Official - Suffix:
Authorized Official - Credentials:LXCSW-R
Authorized Official - Phone:631-928-4815
Mailing Address - Street 1:550 N COUNTRY RD STE E
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1406
Mailing Address - Country:US
Mailing Address - Phone:631-928-4815
Mailing Address - Fax:631-928-4817
Practice Address - Street 1:550 N COUNTRY RD STE E
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1406
Practice Address - Country:US
Practice Address - Phone:631-928-4815
Practice Address - Fax:631-928-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty