Suffolk County Dual Recovery Program

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SUFFOLK COUNTY DUAL RECOVERY PROGRAM

Practice address

15 Horseblock PL
Farmingville, NY 11738-1204

Phone

(631) 854-2571

NPI assigned

Sep 21, 2007

Last updated

Sep 21, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Hickman, LCSW CASACNPI 1538230495

Title

Program Director

Phone

(631) 854-2571

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Vicent Hickman, LCSW, CASAC

  • Clinical Social Worker
  • Farmingville, NY
  • NPI 1538230495
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1477749612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 HORSEBLOCK PL",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117381204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HORSEBLOCK PL",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117381204",
            "telephone_number": "631-854-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK COUNTY DUAL RECOVERY PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "631-854-2571",
        "authorized_official_credential": "LCSW CASAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stony Brook University Medical Center
• Laraine Rene Strom, LMHC
• Suffolk County Department of Health
• Suffolk County Department of Health Services
• Suffolk County Dept. Mental Health Hygiene
• Suffolk County Therapeutic Counseling,LLC
• Stanley Sun, DDS
• Christine Surrusco, RN
• Kaitlyn Symancyk
• Tullia M Taglienti, RN

• Community/Behavioral Health Agency in Farmingville, NY
• Providers in Farmingville, NY by specialty
• Community/Behavioral Health Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.