Healthcare Provider Details

I. General information

NPI: 1720472665
Provider Name (Legal Business Name): PEOPLE TALK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BROADHOLLOW RD SUITE 204
FARMINGDALE NY
11735-4820
US

IV. Provider business mailing address

22 PARSONS DR
STONY BROOK NY
11790-2615
US

V. Phone/Fax

Practice location:
  • Phone: 631-921-9138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072250
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM O'LEARY
Title or Position: THERAPIST
Credential: PSYD
Phone: 631-921-9138