Provider Demographics
NPI:1962736546
Name:BORKOWSKI, MAUREEN A (LCSW-R, CASAC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:A
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TAPPAN AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4106
Mailing Address - Country:US
Mailing Address - Phone:631-581-6846
Mailing Address - Fax:631-581-1919
Practice Address - Street 1:6800 JERICHO TPKE
Practice Address - Street 2:SUITE 122W
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4436
Practice Address - Country:US
Practice Address - Phone:631-235-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4097101YA0400X
NYR071800-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)