Healthcare Provider Details

I. General information

NPI: 1982536637
Provider Name (Legal Business Name): LONG ISLAND PSYCHOTHERAPY SERVICES LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 VENETIAN BLVD
LINDENHURST NY
11757-6330
US

IV. Provider business mailing address

514 VENETIAN BLVD
LINDENHURST NY
11757-6330
US

V. Phone/Fax

Practice location:
  • Phone: 631-620-4662
  • Fax: 631-935-9244
Mailing address:
  • Phone: 631-620-4662
  • Fax: 631-935-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIKAYLA JAYNE ALTINTAS
Title or Position: OWNER
Credential: LCSW
Phone: 631-620-4662