Healthcare Provider Details

I. General information

NPI: 1467137729
Provider Name (Legal Business Name): RESILIENCE PSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N COUNTRY RD SUITE 4
SETAUKET NY
11733
US

IV. Provider business mailing address

46 N COUNTRY RD SUITE 4
SETAUKET NY
11733
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-4844
  • Fax:
Mailing address:
  • Phone: 631-371-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO CACEDA
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 631-371-4844