Healthcare Provider Details

I. General information

NPI: 1124706247
Provider Name (Legal Business Name): SRG TREATMENT SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CARLEY DR
WEST SAYVILLE NY
11796-1007
US

IV. Provider business mailing address

123 CARLEY DR
WEST SAYVILLE NY
11796-1007
US

V. Phone/Fax

Practice location:
  • Phone: 631-796-9641
  • Fax:
Mailing address:
  • Phone: 631-796-9641
  • 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: DR. STEPHANIE ANNE ALLEN
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 631-796-9641