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Organization
KERI MICA LCSW PC
Active
Organization
KERI MICA LCSW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KERI LYNN MICA-SUTTMILLER LCSW-R (PRESIDENT)
(516) 410-7138
Entity
Organization
Contact information
Practice address
176 N VILLAGE AVE, SUITE 2E, ROCKVILLE CENTRE, NY 11570-3800
(516) 410-7138
(516) 679-0736
Mailing address
111 HART STREET, LYNBROOK, NY 11563-1760
(516) 410-7138
(516) 679-0736
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02735202
—
NY
Enumeration date
08/08/2007
Last updated
08/08/2007
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