Provider Demographics
NPI:1649288135
Name:NEGRO, JOANNA MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:NEGRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PEARWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1319
Mailing Address - Country:US
Mailing Address - Phone:631-796-4784
Mailing Address - Fax:
Practice Address - Street 1:790 NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-796-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150811103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637194Medicaid
VM6702Medicare PIN
Q33704Medicare UPIN