Provider Demographics
NPI:1679822621
Name:LENNIHAN, ROBERT C (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:LENNIHAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 FEDERAL LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1621
Mailing Address - Country:US
Mailing Address - Phone:631-331-8637
Mailing Address - Fax:
Practice Address - Street 1:38 STEWART AVE
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-2211
Practice Address - Country:US
Practice Address - Phone:516-434-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075201104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker