Basic Information
| Provider Information | |||||||||
| NPI: | 1427522697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENARO | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314273700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319243741 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2019 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 105376 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 105376-1 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.