Healthcare Provider Details

I. General information

NPI: 1700623543
Provider Name (Legal Business Name): PUTTING IT TOGETHER @ SHARLENE WILLOCK NP IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE STE 12
ROCKVILLE CENTRE NY
11570-3701
US

IV. Provider business mailing address

165 N VILLAGE AVE STE 12
ROCKVILLE CENTRE NY
11570-3701
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8564
  • Fax: 516-874-2477
Mailing address:
  • Phone: 516-350-8564
  • Fax: 516-874-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHARLENE WILLOCK
Title or Position: OWNER
Credential: PMHNP
Phone: 516-350-8564