Healthcare Provider Details

I. General information

NPI: 1891833588
Provider Name (Legal Business Name): METROPOLITAN PSYCHOLOGICAL & LICENSED MASTER SOCIAL WORK SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MONTAUK HIGHWAY SUITE 8
BAY SHORE NY
11706
US

IV. Provider business mailing address

260 MONTAUK HIGHWAY SUITE 8
BAY SHORE NY
11706
US

V. Phone/Fax

Practice location:
  • Phone: 631-647-9011
  • Fax: 631-647-9012
Mailing address:
  • Phone: 631-647-9011
  • Fax: 631-647-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007267-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR050228-1
License Number StateNY

VIII. Authorized Official

Name: SHAFER ZYSMAN
Title or Position: CEO
Credential: PHD, LMSW
Phone: 631-647-9011