Healthcare Provider Details

I. General information

NPI: 1710494760
Provider Name (Legal Business Name): FOCUS FEEDBACK PSYCHOLOGICAL AND OCCUPATIONAL THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 VETERANS MEMORIAL HWY STE 12
COMMACK NY
11725
US

IV. Provider business mailing address

358 VETERANS HWY STE 12
COMMACK NY
11725-4326
US

V. Phone/Fax

Practice location:
  • Phone: 631-240-3030
  • Fax:
Mailing address:
  • Phone: 631-240-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020318
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number014831
License Number StateNY

VIII. Authorized Official

Name: DR. ANDREAS C MICHAELIDES
Title or Position: OWNER
Credential: PHD
Phone: 631-240-3030