Provider Demographics
NPI:1710182894
Name:SUKENIS, KATHY JO (LMSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JO
Last Name:SUKENIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 COVE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1547
Mailing Address - Country:US
Mailing Address - Phone:631-921-2227
Mailing Address - Fax:631-385-9851
Practice Address - Street 1:600 JOHNSON AVE # 27
Practice Address - Street 2:SUITE C-8
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2614
Practice Address - Country:US
Practice Address - Phone:631-921-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069378-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical