Provider Demographics
NPI:1053177105
Name:LENT, CHRISTIAN KENNETH
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:KENNETH
Last Name:LENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEST SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11796
Mailing Address - Country:US
Mailing Address - Phone:631-474-1533
Mailing Address - Fax:
Practice Address - Street 1:93 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796
Practice Address - Country:US
Practice Address - Phone:631-474-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048202-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical