Healthcare Provider Details

I. General information

NPI: 1316626260
Provider Name (Legal Business Name): CREATIVE RESOURCES CONSULTATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 JERICHO TPKE
FLORAL PARK NY
11001-2024
US

IV. Provider business mailing address

174 JERICHO TPKE
FLORAL PARK NY
11001-2024
US

V. Phone/Fax

Practice location:
  • Phone: 516-993-0200
  • Fax: 516-783-7957
Mailing address:
  • Phone: 516-993-0200
  • Fax: 516-783-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES J. NUSS
Title or Position: PRESIDENT AND C.E.O.
Credential: L.C.S.W.
Phone: 516-993-0200