Healthcare Provider Details

I. General information

NPI: 1184677049
Provider Name (Legal Business Name): PLAINVIEW OLD BETHPAGE YOUTH ACTIVITIES COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 TERMINAL DR SUITE 3
PLAINVIEW NY
11803-2312
US

IV. Provider business mailing address

202 TERMINAL DR SUITE 3
PLAINVIEW NY
11803-2312
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-3120
  • Fax: 516-576-3446
Mailing address:
  • Phone: 515-576-3120
  • Fax: 516-576-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MELANIE CONWAY
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 516-576-3120