Healthcare Provider Details

I. General information

NPI: 1174546402
Provider Name (Legal Business Name): FAMILY COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAIN STREET BEINECKE BUILDING
WESTHAMPTON BEACH NY
11978
US

IV. Provider business mailing address

PO BOX 1348
WESTHAMPTON BEACH NY
11978
US

V. Phone/Fax

Practice location:
  • Phone: 631-288-1954
  • Fax: 631-288-1955
Mailing address:
  • Phone: 631-288-1954
  • Fax: 631-288-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9042100A
License Number StateNY

VIII. Authorized Official

Name: MRS. CAROL DELAGE
Title or Position: FINANCIAL COORDINATOR
Credential:
Phone: 631-288-1954