Provider Demographics
NPI:1710273842
Name:SML LICENSED MASTER SOCIAL WORKER SERVICES P.C.
Entity Type:Organization
Organization Name:SML LICENSED MASTER SOCIAL WORKER SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:917-204-5852
Mailing Address - Street 1:22206 BELLA LAGO DR
Mailing Address - Street 2:1509
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4842
Mailing Address - Country:US
Mailing Address - Phone:917-204-5852
Mailing Address - Fax:
Practice Address - Street 1:1455 71ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1707
Practice Address - Country:US
Practice Address - Phone:917-204-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067822252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency