Provider Demographics
NPI:1881046209
Name:DONNA DETURA LCSW P C
Entity Type:Organization
Organization Name:DONNA DETURA LCSW P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DETURA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-379-3436
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-0335
Mailing Address - Country:US
Mailing Address - Phone:631-379-3436
Mailing Address - Fax:631-849-5915
Practice Address - Street 1:701 RT 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8894
Practice Address - Country:US
Practice Address - Phone:631-374-9343
Practice Address - Fax:631-849-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05149811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04154436Medicaid