Organization
THEODORA SLONE LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORA RUSH SLONE LCSW (THERAPIST/ OWNER)
(631) 827-2813
Entity
Organization
Contact information
Practice address
185 DAVENPORT ST, LINDENHURST, NY 11757-5317
(631) 827-2813
Mailing address
185 DAVENPORT ST, LINDENHURST, NY 11757-5317
(631) 827-2813
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06711600
—
NY
Enumeration date
10/26/2021
Last updated
10/26/2021
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