Healthcare Provider Details

I. General information

NPI: 1922720820
Provider Name (Legal Business Name): NORTH VILLAGE MENTAL HEALTH COUNSELING SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NORTH VILLAGE AVENUE 2B
ROCKVILLE CENTRE NY
11570
US

IV. Provider business mailing address

45 NORTH VILLAGE AVENUE 2B
ROCKVILLE CENTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2797
  • Fax:
Mailing address:
  • Phone: 516-536-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LUIS RIVERA
Title or Position: CLINICAL DIRECTOR
Credential: LMHC, LMFT
Phone: 516-536-2797