Provider Demographics
NPI:1891553053
Name:GOVERNALE, EMMA KATE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:KATE
Last Name:GOVERNALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 BERNSTEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-1501
Mailing Address - Country:US
Mailing Address - Phone:631-259-1144
Mailing Address - Fax:
Practice Address - Street 1:93 BERNSTEIN BLVD
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-1501
Practice Address - Country:US
Practice Address - Phone:631-259-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122927104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker