Healthcare Provider Details

I. General information

NPI: 1063357515
Provider Name (Legal Business Name): ANTOINE JEAN-LOUIS MHC-LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HOWELLS RD
BAY SHORE NY
11706-5320
US

IV. Provider business mailing address

160 HOWELLS RD
BAY SHORE NY
11706-5320
US

V. Phone/Fax

Practice location:
  • Phone: 631-954-2554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP141710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: