Provider Demographics
NPI:1396261053
Name:ZEIDNER, GARRET (LCSW)
Entity type:Individual
Prefix:
First Name:GARRET
Middle Name:
Last Name:ZEIDNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:GARRET
Other - Middle Name:
Other - Last Name:ZEIDNER-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 HALLOCK RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3079
Mailing Address - Country:US
Mailing Address - Phone:917-217-8440
Mailing Address - Fax:
Practice Address - Street 1:215 HALLOCK RD STE 1A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3079
Practice Address - Country:US
Practice Address - Phone:917-217-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0928001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical