Provider Demographics
NPI:1669456091
Name:ZARIELLO, SHARON LYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYN
Last Name:ZARIELLO
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 1:152 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1409
Mailing Address - Country:US
Mailing Address - Phone:631-642-9525
Mailing Address - Fax:631-642-9525
Practice Address - Street 1:14 E BROADWAY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1400
Practice Address - Country:US
Practice Address - Phone:631-642-9525
Practice Address - Fax:631-642-9525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02053354Medicaid
NY151910OtherTRICARE
NY6226676OtherUBU
NY7480588OtherVALUE OPTIONS
NYR049107OtherHIP
NY7480588OtherGHI
NY95977OtherVYTRA
NY2064020OtherCIGNA
NYP3150566OtherOXFORD
NY7480588OtherGHI