Healthcare Provider Details

I. General information

NPI: 1114857208
Provider Name (Legal Business Name): DANILACK MENTAL HEALTH COUNSELOR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W PARK AVE STE 228
LONG BEACH NY
11561-3333
US

IV. Provider business mailing address

120 W PARK AVE STE 228
LONG BEACH NY
11561-3333
US

V. Phone/Fax

Practice location:
  • Phone: 631-552-5414
  • Fax:
Mailing address:
  • Phone: 631-552-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAUL DANILACK
Title or Position: OWNER
Credential: LMHC
Phone: 631-552-5414