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DIANE GAVARES LICENSED CLINICAL SOCIAL WORKER P.C.

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Company Details

Name: DIANE GAVARES LICENSED CLINICAL SOCIAL WORKER P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 31 Dec 2019 (5 years ago)
Entity Number: 5679391
ZIP code: 11752
County: Suffolk
Place of Formation: New York
Address: 775 GREENLAWN AVENUE, ISLIP TERRACE, NY, United States, 11752

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 775 GREENLAWN AVENUE, ISLIP TERRACE, NY, United States, 11752

National Provider Identifier

NPI Number:
1417582909
Certification Date:
2020-03-05

Authorized Person:

Name:
DIANE GAVARES
Role:
LICENSED CLINICAL SOCIAL WORKER
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
Yes

Contacts:

Filings

Filing Number Date Filed Type Effective Date
191231000261 2019-12-31 CERTIFICATE OF INCORPORATION 2019-12-31

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State