| Sardonyx Wellness Lcsw Pllc | |
|
93 Main St Ste 1j West Sayville NY 11796-1832 | |
| (631) 509-2575 | |
| (631) 256-9353 |
| Full Name | Sardonyx Wellness Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 93 Main St Ste 1j, West Sayville, New York |
| Authorized Official Name and Position | Melissa Elliott-brogan (OWNER) |
| Authorized Official Contact | 6315092575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sardonyx Wellness Lcsw Pllc Po Box 822 Sayville NY 11782-0822 Ph: (631) 509-2575 | Sardonyx Wellness Lcsw Pllc 93 Main St Ste 1j West Sayville NY 11796-1832 Ph: (631) 509-2575 |
| NPI Number | 1477210698 |
|---|---|
| Provider Enumeration Date | 11/22/2021 |
| Last Update Date | 11/22/2021 |
| Certification Date | 11/22/2021 |
| Medicare PECOS PAC ID | 2668907304 |
|---|---|
| Medicare Enrollment ID | O20241119000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477210698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Melissa D Elliott Brogan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720352164 PECOS PAC ID: 3779888474 Enrollment ID: I20160217001936 |
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