Provider Demographics
NPI:1760956775
Name:POVEROMO, RICHARD (LMSW, CCM, HEC-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:POVEROMO
Suffix:
Gender:M
Credentials:LMSW, CCM, HEC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WATER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9331
Mailing Address - Country:US
Mailing Address - Phone:631-680-8926
Mailing Address - Fax:631-473-5439
Practice Address - Street 1:75 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2119
Practice Address - Country:US
Practice Address - Phone:631-473-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist