Healthcare Provider Details

I. General information

NPI: 1184922460
Provider Name (Legal Business Name): DISCOVERIES THERAPY LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 RT. 112 STE. C
PATCHOGUE NY
11772-1232
US

IV. Provider business mailing address

124 RT. 112 STE. C
PATCHOGUE NY
11772-1232
US

V. Phone/Fax

Practice location:
  • Phone: 631-714-5123
  • Fax: 631-714-5124
Mailing address:
  • Phone: 631-714-5123
  • Fax: 631-714-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075160
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. ELIZABETH QUINLAN
Title or Position: CEO
Credential: LCSW-R
Phone: 631-921-2595