Provider Demographics
NPI:1780856062
Name:LIVING WATERS LCSW PC
Entity type:Organization
Organization Name:LIVING WATERS LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-754-3990
Mailing Address - Street 1:29 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2312
Mailing Address - Country:US
Mailing Address - Phone:631-271-0913
Mailing Address - Fax:631-261-3250
Practice Address - Street 1:29 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-2312
Practice Address - Country:US
Practice Address - Phone:631-271-0913
Practice Address - Fax:631-261-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty