Healthcare Provider Details

I. General information

NPI: 1881136083
Provider Name (Legal Business Name): CONNIE TOALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2016
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STEWART AVE
GARDEN CITY NY
11530-4783
US

IV. Provider business mailing address

585 STEWART AVE STE 700
GARDEN CITY NY
11530-4785
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-7285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011174-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: