Healthcare Provider Details

I. General information

NPI: 1346223252
Provider Name (Legal Business Name): HEART & SOUL COMMUNITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FORDHAM RD
WEST BABYLON NY
11704-5803
US

IV. Provider business mailing address

17 FORDHAM RD
WEST BABYLON NY
11704-5803
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-7011
  • Fax: 631-669-8532
Mailing address:
  • Phone: 631-321-7011
  • Fax: 631-669-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TINA L CALABRESE
Title or Position: PRESIDENT / EXECUTIVE DIRECTOR
Credential:
Phone: 631-321-7011