Barbara Desiderio, LCSW

Individual provider Active NPI Clinical Social Worker · Centerport, NY

NPI 1689680308 · NPPES record last updated May 27, 2010

Key facts

NPI
1689680308
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
075154-1 (NY)
Practice address
10 Benham CT
Centerport, NY 11721-1507
Phone
(631) 239-5259
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
075154-1NYMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 075154-1 NY Yes

Addresses

Primary practice location

10 Benham CT
Centerport, NY 11721-1507

Mailing address

10 Benham CT
Centerport, NY 11721-1507
Phone (631) 239-5259

Other providers in Centerport, NY

All providers in Centerport, NY · Clinical Social Worker in New York

Sources for this page

Verify at the official NPI Registry.