Healthcare Provider Details

I. General information

NPI: 1861886293
Provider Name (Legal Business Name): JML MENTAL HEALTH COUNSELOR P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 09/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 E. MAIN STREET SUITE B22
SMITHTOWN NY
11787
US

IV. Provider business mailing address

82 AVENUE D
HOLBROOK NY
11741
US

V. Phone/Fax

Practice location:
  • Phone: 631-987-3130
  • Fax:
Mailing address:
  • Phone: 631-987-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number005954-1
License Number StateNY

VIII. Authorized Official

Name: JACQUELINE MARIE LOMANDO
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 631-987-3130