Healthcare Provider Details

I. General information

NPI: 1679154900
Provider Name (Legal Business Name): GUIDING BALANCE - PSYCHIATRIC NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W ROE BLVD
PATCHOGUE NY
11772-2569
US

IV. Provider business mailing address

175 FALCON AVE
PATCHOGUE NY
11772-2912
US

V. Phone/Fax

Practice location:
  • Phone: 631-260-1314
  • Fax: 949-561-4740
Mailing address:
  • Phone: 631-260-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
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: DR. AMANDA J WESTON
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 631-680-2124