Healthcare Provider Details

I. General information

NPI: 1285331348
Provider Name (Legal Business Name): INSIEMI PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 DEWY MEADOWS DR
TAYLORS SC
29687-3573
US

IV. Provider business mailing address

508 DEWY MEADOWS DR
TAYLORS SC
29687-3573
US

V. Phone/Fax

Practice location:
  • Phone: 631-806-0919
  • Fax:
Mailing address:
  • Phone: 631-806-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER QUAGLIARIELLO
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW, LISW-CP
Phone: 631-806-0919