Healthcare Provider Details

I. General information

NPI: 1962112920
Provider Name (Legal Business Name): COMFORT CIRCLE MFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 W MERRICK RD STE 7
FREEPORT NY
11520-3357
US

IV. Provider business mailing address

294 W MERRICK RD STE 7
FREEPORT NY
11520-3357
US

V. Phone/Fax

Practice location:
  • Phone: 631-440-1148
  • Fax:
Mailing address:
  • Phone: 631-440-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY POWELL
Title or Position: PRESIDENT
Credential: LMFT
Phone: 347-870-9039