Provider Demographics
NPI:1689037574
Name:SILVER LININGS A SAFE HAVEN
Entity Type:Organization
Organization Name:SILVER LININGS A SAFE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-905-6884
Mailing Address - Street 1:88 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2221
Mailing Address - Country:US
Mailing Address - Phone:631-905-6884
Mailing Address - Fax:631-909-2629
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-905-6884
Practice Address - Fax:631-909-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty