Healthcare Provider Details

I. General information

NPI: 1598089740
Provider Name (Legal Business Name): COUNSELING SERVICES OF EDNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE SUITE 300
HEMPSTEAD NY
11550-3718
US

IV. Provider business mailing address

175 FULTON AVE SUITE 300
HEMPSTEAD NY
11550-3718
US

V. Phone/Fax

Practice location:
  • Phone: 516-481-0052
  • Fax: 516-481-2115
Mailing address:
  • Phone: 516-481-0052
  • Fax: 516-481-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number18 002953
License Number StateNY

VIII. Authorized Official

Name: MS. ANNE NANCY PETRARO
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 516-481-0052