Healthcare Provider Details

I. General information

NPI: 1750673992
Provider Name (Legal Business Name): COUNSELING & PSYCHOLOGICAL SERVICES FOR THE INDIVIDUAL, FAMILY, GROUP,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MERRICK AVE
MERRICK NY
11566-3434
US

IV. Provider business mailing address

124 MERRICK AVE
MERRICK NY
11566-3434
US

V. Phone/Fax

Practice location:
  • Phone: 516-868-8401
  • Fax: 516-239-0443
Mailing address:
  • Phone: 516-868-8401
  • Fax: 516-239-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009010
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number009010
License Number StateNY

VIII. Authorized Official

Name: DR. SHAUL RABINOWITZ
Title or Position: DIRECTOR
Credential: PH.D
Phone: 516-868-8401