Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 27977 | NY |
Y | 104100000X | Social Worker | 096137 | NY |
NPI | 1083075063 |
---|---|
Provider Name | Brittany Starrantino |
First Address | Commack, NY 11725-2937 |
Second Address | Commack, NY 11725-2937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2016 |
Last Update Date | 17/03/2016 |