Provider Demographics
NPI:1942383625
Name:LAFEMINA, SAL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAL
Middle Name:
Last Name:LAFEMINA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-1405
Mailing Address - Country:US
Mailing Address - Phone:631-363-7534
Mailing Address - Fax:631-363-0822
Practice Address - Street 1:160 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2568
Practice Address - Country:US
Practice Address - Phone:631-363-0822
Practice Address - Fax:631-363-0822
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040740-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4H931Medicare ID - Type Unspecified