Organization
CATHERINE PROVENZANO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHERINE PROVENZANO LCSW (CLINICAL SOCIAL WORKER)
(631) 487-5162
Entity
Organization
Contact information
Practice address
1050 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776-1214
(631) 487-5162
Mailing address
1050 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776-1214
(631) 487-5162
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
081438
NY
Other
Enumeration date
10/01/2014
Last updated
10/01/2014
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