Provider Demographics
NPI:1689890402
Name:GARGANO, SAGE P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAGE
Middle Name:P
Last Name:GARGANO
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 1:18 NIGHTINGALE CT
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-801-3818
Mailing Address - Fax:
Practice Address - Street 1:725 VETERANS MEMORIAL HWY
Practice Address - Street 2:BLDG 151 NORTH COUNTY COMPLEX
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-6410
Practice Address - Fax:631-853-6338
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0280741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker