Healthcare Provider Details

I. General information

NPI: 1588012702
Provider Name (Legal Business Name): ADELPHI UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 CAMBRIDGE AVE 325
GARDEN CITY NY
11530-4235
US

IV. Provider business mailing address

158 CAMBRIDGE AVE 325
GARDEN CITY NY
11530-4235
US

V. Phone/Fax

Practice location:
  • Phone: 516-877-4841
  • Fax:
Mailing address:
  • Phone: 516-877-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JACK HERSKOVITS
Title or Position: DIRECTOR
Credential: PSY.D.
Phone: 516-877-4841