Provider Demographics
NPI:1295978583
Name:PERLINE, SANDRA I (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:I
Last Name:PERLINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:I
Other - Last Name:MEYERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:20 GILBERT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5326
Mailing Address - Country:US
Mailing Address - Phone:631-220-5523
Mailing Address - Fax:
Practice Address - Street 1:20 GILBERT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5326
Practice Address - Country:US
Practice Address - Phone:631-220-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0793311041C0700X
NY0770551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical