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General NPI Number Information
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NPI Number | 1134660624
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Entity Type | Organization
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Legal Business Name | LONG ISLAND PSYCHOTHERAPY & COUNSELING, LCSW P.C.
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 97 POWERHOUSE RD STE 104
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2046
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Country | US
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Telephone | 347-772-8373
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Fax |
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Provider Business Mailing Address
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Address Line | 8 DALTON LN
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3909
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Country | US
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Telephone | 347-772-8373
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PABLO IDEZ
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Credential |
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Telephone | 347-772-8373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 063837
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License Number State | NY
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