Provider Demographics
NPI:1932482593
Name:SVENTORAITIS, LIANA KRISTEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LIANA
Middle Name:KRISTEN
Last Name:SVENTORAITIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LIANA
Other - Middle Name:KRISTEN
Other - Last Name:MELINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:240 LONG ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-3123
Mailing Address - Country:US
Mailing Address - Phone:631-782-6200
Mailing Address - Fax:631-491-5354
Practice Address - Street 1:240 LONG ISLAND AVE
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-3123
Practice Address - Country:US
Practice Address - Phone:631-782-6200
Practice Address - Fax:631-491-5354
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0777331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical