Provider Demographics
NPI:1609005776
Name:SOLOMON, LAQUETTA D (LCSW)
Entity Type:Individual
Prefix:DR
First Name:LAQUETTA
Middle Name:D
Last Name:SOLOMON
Suffix:
Gender:F
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:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-0401
Mailing Address - Country:US
Mailing Address - Phone:631-800-1975
Mailing Address - Fax:631-918-7777
Practice Address - Street 1:606 JOHNSON AVE STE 17
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2688
Practice Address - Country:US
Practice Address - Phone:631-800-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07674811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical