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General NPI Number Information
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NPI Number | 1043606015
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH NURSE PRACTITIONER PSYCHIATRIC SERVICES PC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 28 ANNANDALE RD
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City | COMMACK
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State | NY
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Zip | 11725-1745
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Country | US
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Telephone | 631-387-1496
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Fax | 631-893-4020
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Provider Business Mailing Address
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Address Line | 28 ANNANDALE RD
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City | COMMACK
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State | NY
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Zip | 11725-1745
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Country | US
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Telephone | 631-387-1496
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Fax | 631-893-4020
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBRA COANE
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Credential |
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Telephone | 631-681-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401327
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License Number State | NY
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