| Doctor Name: | MR. KENNETH ROBERT SERGIACOMI |
| NPI Number: | 1336355395 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.S.W. |
| License Number: | 0735881-1 |
| Business Practice Address: | 1050 Hallock Ave Suite 4 Port Jefferson Station, NY - 117761214 |
| Business Phone Number: | 6313840624 |
| Business Fax Number: | |
| Mailing Address: | 1050 Hallock Ave, Suite 4 PORT JEFFERSON STATION |
| State: | NY |
| Postal Code: | 117761214 |
| Phone Number: | 6313840624 |
| Fax Number: | |
| NPI Enumeration Date: | 05/15/2007 |
| NPI Last Update Date: | 10/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 0735881-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |