Provider Demographics
NPI:1295763852
Name:LONG ISLAND ELDER CARE LCSW PLLC
Entity type:Organization
Organization Name:LONG ISLAND ELDER CARE LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN-ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-979-3498
Mailing Address - Street 1:732 SMITHTOWN BYP STE A55
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5020
Mailing Address - Country:US
Mailing Address - Phone:631-320-1070
Mailing Address - Fax:631-320-1071
Practice Address - Street 1:732 SMITHTOWN BYP STE A55
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5020
Practice Address - Country:US
Practice Address - Phone:631-320-1070
Practice Address - Fax:631-320-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO335511104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty