Healthcare Provider Details

I. General information

NPI: 1235205360
Provider Name (Legal Business Name): ADC PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 BROADWAY SUITE # 1
HEWLETT NY
11557-1630
US

IV. Provider business mailing address

1728 BROADWAY SUITE # 1
HEWLETT NY
11557-1630
US

V. Phone/Fax

Practice location:
  • Phone: 516-596-0073
  • Fax: 516-599-5698
Mailing address:
  • Phone: 516-596-0073
  • Fax: 516-599-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number010847
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007842
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010263
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0318131
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL J SALAMON
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 516-596-0073