1295062693 NPI number — KONTOS PSYCHOTHERAPY LCSW PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295062693 NPI number — KONTOS PSYCHOTHERAPY LCSW PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KONTOS PSYCHOTHERAPY LCSW PC
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:
Provider Other Organization Name Type Code:
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:
1295062693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 872
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDENHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11757-0872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-592-2179
Provider Business Mailing Address Fax Number:
631-592-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 S WELLWOOD AVE
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
LINDENHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11757-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-592-2179
Provider Business Practice Location Address Fax Number:
631-592-8060
Provider Enumeration Date:
11/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KONTOS
Authorized Official First Name:
KALLIRROY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-592-2179

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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