1003496308 NPI number — LONG ISLAND NC MENTAL HEALTH COUNSELING P.C.

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 1003496308 NPI number — LONG ISLAND NC MENTAL HEALTH COUNSELING P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND NC MENTAL HEALTH COUNSELING P.C.
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:
LONG ISLAND FAMILY AND TRAUMA COUNSELING SERVICES
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:
1003496308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24520 GRAND CENTRAL PKWY APT 5E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEROSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11426-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-341-8924
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 NORTHERN BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 404- #0830
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-360-0147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CARRERO
Authorized Official First Name:
NICCOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-341-8924

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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