Provider Demographics
NPI:1881441434
Name:METAMORPHOSIS, LMSW P.C.
Entity type:Organization
Organization Name:METAMORPHOSIS, LMSW P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUNGUZI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:631-219-6598
Mailing Address - Street 1:51 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-1807
Mailing Address - Country:US
Mailing Address - Phone:631-219-6598
Mailing Address - Fax:631-229-3989
Practice Address - Street 1:26 COLONIAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1015
Practice Address - Country:US
Practice Address - Phone:631-229-3688
Practice Address - Fax:631-229-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty