Organization
SOCIAL WORK FOR COUNSELING FOR INSPIRATIONAL LIVING LCSW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH G. LENT LCSW (OWNER)
(631) 474-1533
Entity
Organization
Contact information
Practice address
6 ROOSEVELT AVE STE 2, PORT JEFFERSON STATION, NY 11776-3364
(631) 474-1533
(631) 474-1533
Mailing address
6 ROOSEVELT AVE STE 2, PORT JEFFERSON STATION, NY 11776-3364
(631) 474-1533
(631) 474-1533
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
R048202-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02364309
—
NY
Enumeration date
10/15/2009
Last updated
05/16/2019
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