Healthcare Provider Details

I. General information

NPI: 1003496308
Provider Name (Legal Business Name): LONG ISLAND NC MENTAL HEALTH COUNSELING P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 NORTHERN BOULEVARD SUITE 404- #0830
MANHASSET NY
11030-1103
US

IV. Provider business mailing address

24520 GRAND CENTRAL PKWY APT 5E
BELLEROSE NY
11426-2711
US

V. Phone/Fax

Practice location:
  • Phone: 516-360-0147
  • Fax:
Mailing address:
  • Phone: 516-341-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICCOLE CARRERO
Title or Position: OWNER
Credential: LMHC
Phone: 516-341-8924