Sacred Space an Integrative Wellness Community

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SACRED SPACE AN INTEGRATIVE WELLNESS COMMUNITY

Practice address

445 Little East Neck Rd
West Babylon, NY 11704-6543

Phone

(516) 265-2983

NPI assigned

Oct 13, 2020

Organization subpart

No

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

Authorized official

Name

Jennifer Marie Hairston-DavisNPI 1396849865

Title

LCSW-R

Phone

(516) 265-2983

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Marie Hairston-Davis, LMSW

  • Social Worker
  • Northport, NY
  • NPI 1396849865
  NPD Authorized official

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1922606896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MARINE LN",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117048208",
            "telephone_number": "516-265-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 LITTLE EAST NECK RD",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117046543",
            "telephone_number": "516-265-2983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE AN INTEGRATIVE WELLNESS COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "HAIRSTON-DAVIS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "LCSW-R",
        "authorized_official_telephone_number": "516-265-2983"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Holistic_Hairston@yahoo.com",
            "affiliation": "N",
            "address_1": "445 Little East Neck Rd",
            "city": "West Babylon",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117046543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Darlene Russo, MS, CCC-SLP, TSSLD
• Katherine Mary Russo
• Alyson Ryan, LCSW
• Carolyn Teresa Ryan, M.A., LCAT, ATR-BC
• Sadia Saad
• Shivani Sajikumar, OD
• Janet Anna Saju, MS, OTR/L
• Merlyn Dulnoan Sakai
• Arlette Salim
• Allison Sammartano, RDN

• Clinical Social Worker in West Babylon, NY
• Providers in West Babylon, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.