Provider Demographics
NPI:1154766350
Name:SERENITY ZONE LCSW PLLC
Entity type:Organization
Organization Name:SERENITY ZONE LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNATZOR
Authorized Official - Suffix:
Authorized Official - Credentials:CSMC
Authorized Official - Phone:516-432-1790
Mailing Address - Street 1:4025 AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1221
Mailing Address - Country:US
Mailing Address - Phone:516-432-1790
Mailing Address - Fax:516-432-0760
Practice Address - Street 1:4025 AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1221
Practice Address - Country:US
Practice Address - Phone:516-432-1790
Practice Address - Fax:516-432-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074680-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty