1922166628 NPI number — FIRST LIGHT PSYCHOLOGICAL SERVICES, P.L.L.C.

Table of content: (NPI 1922166628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922166628 NPI number — FIRST LIGHT PSYCHOLOGICAL SERVICES, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST LIGHT PSYCHOLOGICAL SERVICES, P.L.L.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:
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:
1922166628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 SALLY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-1434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-637-0689
Provider Business Mailing Address Fax Number:
631-414-7178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 BROADHOLLOW RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
FARMINGDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11735-4820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-414-7181
Provider Business Practice Location Address Fax Number:
631-414-7178
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DESANTIS
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-414-7181

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  68-60276 , 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)





Copyright © 2007-2025 www.npivalidator.com