1013339340 NPI number — COMPASSIONATE COUNSELING COLLECTIVE

Table of content: (NPI 1013339340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013339340 NPI number — COMPASSIONATE COUNSELING COLLECTIVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE COUNSELING COLLECTIVE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELIZABETH DUDDY NAVARETTA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013339340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 OLEETA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT SINAI
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11766-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-988-3559
Provider Business Mailing Address Fax Number:
631-331-5534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
538 ROUTE 25A
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ROCKY POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11778-9089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-988-3559
Provider Business Practice Location Address Fax Number:
631-331-5534
Provider Enumeration Date:
01/06/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUDDY-NAVARETTA
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
DIRECTOR AND LCSWR
Authorized Official Telephone Number:
631-988-3559

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  050201 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPI 1427129048 . This is a "NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1427129048 . This is a "NPI SOLE PROPRIETOR" identifier . This identifiers is of the category "OTHER".