Healthcare Provider Details

I. General information

NPI: 1568307767
Provider Name (Legal Business Name): POSITIVE ENERGY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 MIDDLE RD
BAYPORT NY
11705-1925
US

IV. Provider business mailing address

597 MIDDLE RD
BAYPORT NY
11705-1925
US

V. Phone/Fax

Practice location:
  • Phone: 631-533-0708
  • Fax:
Mailing address:
  • Phone: 631-533-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BETH MILLER
Title or Position: OWNER
Credential: LCSW-R
Phone: 631-327-0090