Healthcare Provider Details

I. General information

NPI: 1013441401
Provider Name (Legal Business Name): THE LONG ISLAND MENTAL HEALTH COUNSELING GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 STEWART AVE SUITE 100
BETHPAGE NY
11714-1601
US

IV. Provider business mailing address

1211 STEWART AVE SUITE 100
BETHPAGE NY
11714-1601
US

V. Phone/Fax

Practice location:
  • Phone: 516-428-0741
  • Fax: 516-465-3998
Mailing address:
  • Phone: 516-428-0741
  • Fax: 516-465-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004224
License Number StateNY

VIII. Authorized Official

Name: MRS. KRISTEN HERBERT-DELANEY
Title or Position: OWNER
Credential: LMHC
Phone: 516-428-0741