Provider Demographics
NPI:1972748200
Name:MOGAVERO, ADRIENNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:MOGAVERO
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 1:2174 HEWLETT AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3606
Mailing Address - Country:US
Mailing Address - Phone:516-546-2333
Mailing Address - Fax:
Practice Address - Street 1:23 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1410
Practice Address - Country:US
Practice Address - Phone:516-589-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069249-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical