Healthcare Provider Details

I. General information

NPI: 1225387772
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION OF NASSAU COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 THE TER
PLANDOME NY
11030-1348
US

IV. Provider business mailing address

16 MAIN ST
HEMPSTEAD NY
11550-4020
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-1249
  • Fax: 516-365-9799
Mailing address:
  • Phone: 516-489-2322
  • Fax: 516-489-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: DAVID NEMIROFF
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 516-489-2322